Provider Demographics
NPI:1407091499
Name:METHODIUS-RAYFORD, WALAYA CHIYEM (MD)
Entity Type:Individual
Prefix:
First Name:WALAYA
Middle Name:CHIYEM
Last Name:METHODIUS-RAYFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:WALAYA
Other - Middle Name:CHIYEM
Other - Last Name:METHODIUS-NGWODO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 54888
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-0888
Mailing Address - Country:US
Mailing Address - Phone:404-350-9505
Mailing Address - Fax:404-350-1611
Practice Address - Street 1:1718 PEACHTREE ST NW
Practice Address - Street 2:SUITE 360
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2452
Practice Address - Country:US
Practice Address - Phone:404-350-9505
Practice Address - Fax:404-350-1611
Is Sole Proprietor?:No
Enumeration Date:2008-12-05
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0619852086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery