Provider Demographics
NPI:1003058785
Name:JAYRAY URODYNAMICS LLC
Entity Type:Organization
Organization Name:JAYRAY URODYNAMICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VINTONNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:NAIDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-284-2228
Mailing Address - Street 1:3951 SNAPFINGER PKWY
Mailing Address - Street 2:SUITE 350
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-3202
Mailing Address - Country:US
Mailing Address - Phone:404-284-2228
Mailing Address - Fax:404-284-3855
Practice Address - Street 1:3951 SNAPFINGER PKWY
Practice Address - Street 2:SUITE 350
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-3202
Practice Address - Country:US
Practice Address - Phone:404-284-2228
Practice Address - Fax:404-284-3855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA31482332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies