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General NPI Number Information
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NPI Number | 1700251428
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Entity Type | Individual
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Provider Name | DAPHNE MICHELLE RAY-LEVERETT FNP
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Gender | Female
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Dates
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Enumeration Date | 12/07/2015
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Last Update Date | 01/02/2016
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Provider Practice Location Address
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Address Line | 105 HIGHGROVE PL
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City | MCDONOUGH
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State | GA
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Zip | 30253-5979
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Country | US
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Telephone | 678-699-9496
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Fax |
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Provider Business Mailing Address
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Address Line | 105 HIGHGROVE PLACE
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City | MCDONOUGH
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State | GA
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Zip | 30253
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Country | US
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Telephone | 678-699-9496
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 167925
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License Number State | GA
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