MEDICARE: LAURIE LEIGH RAY WHNP

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	363LW0102X	Women's Health Nurse Practitioner	080527-23	NH
2	363LW0102X	Women's Health Nurse Practitioner	APRN-NP217652	GA
3	363LW0102X	Women's Health Nurse Practitioner	421055	NY

General Provider Information

NPI Number	:	1669730511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE LEIGH RAY WHNP

Provider Business Mailing Address
First Line	:	440 MORELAND AVE SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30316-1926
Country	:	US
Telephone Number	:	404-688-9300
Fax Number	:

Provider Business Practice Location Address
First Line	:	440 MORELAND AVE SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30316-1926
Country	:	US
Telephone Number	:	404-688-9300
Fax Number	:

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

Provider Enumeration Date	:	04/29/2012
Last Update Date	:	11/29/2025

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