Provider Demographics
NPI:1518652536
Name:RAY, JESSICA (DO)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WOODCOCK RD UNIT 1315
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-1087
Mailing Address - Country:US
Mailing Address - Phone:202-702-3663
Mailing Address - Fax:
Practice Address - Street 1:601 E 66TH ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4519
Practice Address - Country:US
Practice Address - Phone:912-662-0088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-06
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA14832390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program