Provider Demographics
NPI:1629395140
Name:RAY, MICHELLE ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANN
Last Name:RAY
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:207 OLDE OAK WAY
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-6130
Mailing Address - Country:US
Mailing Address - Phone:770-928-3332
Mailing Address - Fax:
Practice Address - Street 1:300 TOWER RD NE
Practice Address - Street 2:SUITE 200
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-9404
Practice Address - Country:US
Practice Address - Phone:770-427-5717
Practice Address - Fax:770-514-6744
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2010-11-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA5813363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical