Provider Demographics
NPI:1639114697
Name:RAY, ANGELA S (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:S
Last Name:RAY
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 1:725 GLENWOOD DRIVE
Mailing Address - Street 2:SUITE E487
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404
Mailing Address - Country:US
Mailing Address - Phone:423-697-0014
Mailing Address - Fax:423-648-6280
Practice Address - Street 1:2552 DESALES AVENUE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404
Practice Address - Country:US
Practice Address - Phone:423-697-0014
Practice Address - Fax:423-648-6280
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21926207P00000X
GA056351207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10058874OtherAMERIGROUP
GA865075828Medicaid
GA865075828AMedicaid
GA865075828CMedicaid
SC865075828EMedicaid
GA865075828BMedicaid
GA865075828Medicaid
SCP00276719Medicare PIN
GAP00243656Medicare PIN
GA93BFBCHMedicare PIN
H29179Medicare UPIN
GA865075828CMedicaid