Provider Demographics
NPI:1518917061
Name:HORNSBY, RAE LYNNE (MD)
Entity Type:Individual
Prefix:
First Name:RAE
Middle Name:LYNNE
Last Name:HORNSBY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 MILESTONE WAY
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-5065
Mailing Address - Country:US
Mailing Address - Phone:864-558-0092
Mailing Address - Fax:855-269-6611
Practice Address - Street 1:142 MILESTONE WAY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-5065
Practice Address - Country:US
Practice Address - Phone:864-558-0092
Practice Address - Fax:864-558-0093
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC187582080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC57-6007863032OtherBCBS OF SC
SC6230171OtherCIGNA
SC57-6007863037OtherBLUE CHOICE OF SC
SCT29154Medicaid
SCAA11567951Medicare PIN
SC57-6007863032OtherBCBS OF SC