Provider Demographics
NPI:1093870479
Name:RAYMOND, KATE REKER (DO)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:REKER
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:REKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:221 TECHNOLOGY PKWY NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1369
Mailing Address - Country:US
Mailing Address - Phone:762-235-1000
Mailing Address - Fax:
Practice Address - Street 1:150 GENTILLY BLVD
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-8522
Practice Address - Country:US
Practice Address - Phone:770-382-2580
Practice Address - Fax:770-386-7910
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045938207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000798894AMedicaid
GA08BDPDZMedicare ID - Type Unspecified
GA000798894AMedicaid