MEDICARE: MR. RAYMOND EUGENE POLK PA-C

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	363AM0700X	Medical Physician Assistant	002539	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467454314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAYMOND EUGENE POLK PA-C

Provider Business Mailing Address
First Line	:	PO BOX 742616
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-2616
Country	:	US
Telephone Number	:	770-219-8420
Fax Number	:

Provider Business Practice Location Address
First Line	:	134 ANSLEY DR STE 400
Second Line	:
City	:	DAHLONEGA
State	:	GA
Zip	:	30533-1642
Country	:	US
Telephone Number	:	706-864-1580
Fax Number	:	770-219-9561

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	01/21/2021

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