Provider Demographics
NPI:1679504468
Name:RAUX, MARY ELLEN (MD)
Entity Type:Individual
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First Name:MARY ELLEN
Middle Name:
Last Name:RAUX
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1984 PEACHTREE RD NW
Mailing Address - Street 2:STE 515
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-5219
Mailing Address - Country:US
Mailing Address - Phone:404-351-1754
Mailing Address - Fax:404-351-7121
Practice Address - Street 1:1640 AIRPORT RD NW
Practice Address - Street 2:STE 110
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7038
Practice Address - Country:US
Practice Address - Phone:678-202-2074
Practice Address - Fax:770-590-1442
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
GA025256207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00272522Medicaid
GA00272522Medicaid