Provider Demographics
NPI:1326323460
Name:RAY, LYNLEY
Entity Type:Individual
Prefix:
First Name:LYNLEY
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 TWIN SPRINGS RD NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-3557
Mailing Address - Country:US
Mailing Address - Phone:404-840-8156
Mailing Address - Fax:404-842-0109
Practice Address - Street 1:550 TWIN SPRINGS RD NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-3557
Practice Address - Country:US
Practice Address - Phone:404-840-8156
Practice Address - Fax:404-842-0109
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005075235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000921852AMedicaid