Provider Demographics
NPI:1154487460
Name:WEXLER, RAYMOND H (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:H
Last Name:WEXLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3875 AUSTELL RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1103
Mailing Address - Country:US
Mailing Address - Phone:770-944-0811
Mailing Address - Fax:770-944-0829
Practice Address - Street 1:3875 AUSTELL ROAD
Practice Address - Street 2:SUITE 303
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1151
Practice Address - Country:US
Practice Address - Phone:770-944-0811
Practice Address - Fax:770-944-0829
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2014-05-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA025687207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD41366Medicare UPIN