MEDICARE: WALAYA CHIYEM METHODIUS-RAYFORD MD

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	2086S0129X	Vascular Surgery Physician	061985	GA

General Provider Information

NPI Number	:	1407091499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WALAYA CHIYEM METHODIUS-RAYFORD MD

Provider Business Mailing Address
First Line	:	11050 CRABAPPLE RD STE 105B
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30075-2456
Country	:	US
Telephone Number	:	317-679-7868
Fax Number	:

Provider Business Practice Location Address
First Line	:	11050 CRABAPPLE RD STE 105B
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30075-2456
Country	:	US
Telephone Number	:	317-679-7868
Fax Number	:

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

Provider Enumeration Date	:	12/05/2008
Last Update Date	:	04/23/2026

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