MEDICARE: JOSE ARI G LARAYA M.D.

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	207Q00000X	Family Medicine Physician	MD0000029040	TN

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	:	1639120868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE ARI G LARAYA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 931263
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	31193-1263
Country	:	US
Telephone Number	:	901-949-2316
Fax Number	:	901-377-6806

Provider Business Practice Location Address
First Line	:	6570 STAGE RD STE 100
Second Line	:
City	:	BARTLETT
State	:	TN
Zip	:	38134-2839
Country	:	US
Telephone Number	:	901-949-2316
Fax Number	:	901-746-8926

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	09/08/2023

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