Provider Demographics
NPI:1467927848
Name:RAY, JACOB
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:RAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 PRINCETON AVE SW STE 200A
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35211-1321
Mailing Address - Country:US
Mailing Address - Phone:205-786-2776
Mailing Address - Fax:205-786-6227
Practice Address - Street 1:833 PRINCETON AVE SW STE 200A
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1321
Practice Address - Country:US
Practice Address - Phone:205-786-2776
Practice Address - Fax:205-786-6227
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-145994363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology