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General NPI Number Information
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NPI Number | 1629219118
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Entity Type | Individual
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Provider Name | ULYS RANDALL RINER PA
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Gender | Male
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Dates
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Enumeration Date | 03/13/2009
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 855 W BROAD ST STE A
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City | ATHENS
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State | GA
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Zip | 30601-2511
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Country | US
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Telephone | 706-621-7575
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Fax | 833-305-0340
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Provider Business Mailing Address
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Address Line | 1061 DOWDY ROAD SUITE 101
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City | ATHENS
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State | GA
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Zip | 30606-3819
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Country | US
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Telephone | 706-621-7575
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Fax | 833-305-0340
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 000207
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License Number State | GA
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