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General NPI Number Information
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NPI Number | 1205964046
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Entity Type | Individual
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Provider Name | TAMELA MARIE RAYNOR P.A.-C
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Gender | Female
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 01/08/2009
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Provider Practice Location Address
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Address Line | 217 S MAIN ST
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City | TROY
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State | NC
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Zip | 27371-3201
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Country | US
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Telephone | 910-572-1393
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Fax |
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Provider Business Mailing Address
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Address Line | 1743 SOUTHPOINT LN
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City | BADIN LAKE
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State | NC
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Zip | 28127-9141
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Country | US
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Telephone | 336-461-3614
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Fax | 336-461-3614
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 101695
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License Number State | NC
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