Provider Demographics
NPI:1427041631
Name:HOWARD, RAYMOND III (MD)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:
Last Name:HOWARD
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 JOHN MADDOX DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1494
Mailing Address - Country:US
Mailing Address - Phone:706-235-0116
Mailing Address - Fax:706-235-5533
Practice Address - Street 1:107 JOHN MADDOX DRIVE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1494
Practice Address - Country:US
Practice Address - Phone:706-235-0116
Practice Address - Fax:706-235-5533
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2022-01-20
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
GA051145207YS0123X
GA51145207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00941399AMedicaid
GAH58334Medicare UPIN
GA04BDCJPMedicare PIN