MEDICARE: JEREMY RAIFORD

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1437984549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY RAIFORD

Provider Business Mailing Address
First Line	:	955 POWELL AVE SW
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98057-2908
Country	:	US
Telephone Number	:	425-277-1311
Fax Number	:

Provider Business Practice Location Address
First Line	:	1445 MONROE DR NE APT D11
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30324-5338
Country	:	US
Telephone Number	:	706-818-5905
Fax Number	:

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

Provider Enumeration Date	:	09/06/2024
Last Update Date	:	03/15/2026

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Directions to “ JEREMY RAIFORD ” Practice Location

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