Provider Demographics
NPI:1629046859
Name:MAYER, RAOUL (MD)
Entity Type:Individual
Prefix:DR
First Name:RAOUL
Middle Name:
Last Name:MAYER
Suffix:
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 1:2675 N DECATUR RD STE 710
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-6135
Mailing Address - Country:US
Mailing Address - Phone:404-501-7490
Mailing Address - Fax:404-501-7430
Practice Address - Street 1:2675 N DECATUR RD STE 710
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033
Practice Address - Country:US
Practice Address - Phone:404-501-7490
Practice Address - Fax:404-501-7430
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043701208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00751737AMedicaid
GAG17767Medicare UPIN
GA28BBBBQMedicare PIN