Provider Demographics
NPI:1669471413
Name:SCHETTINO, RAYMOND L (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:L
Last Name:SCHETTINO
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 1:2500 HOSPITAL BLVD
Mailing Address - Street 2:SUITE 450
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4907
Mailing Address - Country:US
Mailing Address - Phone:770-343-8675
Mailing Address - Fax:770-343-8773
Practice Address - Street 1:2500 HOSPITAL BLVD
Practice Address - Street 2:SUITE 450
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4907
Practice Address - Country:US
Practice Address - Phone:770-343-8675
Practice Address - Fax:770-343-8773
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032814174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00428293AMedicaid
GA3416408OtherAETNA
GA297013Medicaid
GA10034919Medicaid
GA04BDBDHMedicare ID - Type Unspecified
GA297013Medicaid