Provider Demographics
NPI:1659563856
Name:JEFFREY M RAWLINGS
Entity Type:Organization
Organization Name:JEFFREY M RAWLINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEB
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:ADMIN
Authorized Official - Phone:850-668-6888
Mailing Address - Street 1:2056 CENTRE POINTE LN
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4300
Mailing Address - Country:US
Mailing Address - Phone:850-668-6888
Mailing Address - Fax:850-668-0125
Practice Address - Street 1:2056 CENTRE POINTE LN
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4300
Practice Address - Country:US
Practice Address - Phone:850-668-6888
Practice Address - Fax:850-668-0125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83584174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8969Medicare PIN