Provider Demographics
NPI:1619207958
Name:WILLIAM A. RAFULS, MD, INC.
Entity Type:Organization
Organization Name:WILLIAM A. RAFULS, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAFULS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-762-9182
Mailing Address - Street 1:2158 NORTHGATE PARK LN STE 220
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-6959
Mailing Address - Country:US
Mailing Address - Phone:423-762-9182
Mailing Address - Fax:423-508-8361
Practice Address - Street 1:2158 NORTHGATE PARK LN STE 220
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37415-6959
Practice Address - Country:US
Practice Address - Phone:423-762-9182
Practice Address - Fax:423-508-8361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN357422084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1514712Medicaid
TN1514712Medicaid
D28017Medicare UPIN