Provider Demographics
NPI:1003826512
Name:THWEATT, RAYFORD W
Entity Type:Individual
Prefix:
First Name:RAYFORD
Middle Name:W
Last Name:THWEATT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 55310
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5310
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:619 19TH STREET SOUTH
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233
Practice Address - Country:US
Practice Address - Phone:205-934-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL087752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051503141OtherFED. BCBS OF AL
AL123277Medicaid
AL051598203OtherBCBS
AL051501559OtherBCBS OF AL
AL051501559Medicaid
AL260047164OtherRR MEDICARE
AL330500513OtherMEDICAID REHAB
AL51110415OtherBCBS
ALC75914OtherVIVA
AL051598214OtherBCBS
AL051503141OtherFED. BCBS OF AL