Provider Demographics
NPI:1083871834
Name:RAY, ANDREW L (PA)
Entity Type:Individual
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First Name:ANDREW
Middle Name:L
Last Name:RAY
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Gender:M
Credentials:PA
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Mailing Address - Street 1:120 OSIGIAN BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-7880
Mailing Address - Country:US
Mailing Address - Phone:478-953-5358
Mailing Address - Fax:478-953-5340
Practice Address - Street 1:3051 WATSON BLVD
Practice Address - Street 2:SUITE 525
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-8536
Practice Address - Country:US
Practice Address - Phone:478-953-4563
Practice Address - Fax:478-953-4683
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
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Provider Licenses
StateLicense IDTaxonomies
GA005322363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant