MEDICARE: MEDJINA RAYMOND NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	RN267526	GA
2	163W00000X	Registered Nurse	630292	NY
3	363LG0600X	Gerontology Nurse Practitioner	RN267526	GA

General Provider Information

NPI Number	:	1316209604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEDJINA RAYMOND NP

Provider Business Mailing Address
First Line	:	227 ASPEN VALLEY LN
Second Line	:
City	:	DALLAS
State	:	GA
Zip	:	30157-1462
Country	:	US
Telephone Number	:	678-468-9601
Fax Number	:

Provider Business Practice Location Address
First Line	:	227 ASPEN VALLEY LN
Second Line	:
City	:	DALLAS
State	:	GA
Zip	:	30157-1462
Country	:	US
Telephone Number	:	678-468-9601
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2012
Last Update Date	:	02/26/2026

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