Provider Demographics
NPI:1689926651
Name:RAYTCHEV, VESSELIN STOYANOV (NP-C)
Entity Type:Individual
Prefix:
First Name:VESSELIN
Middle Name:STOYANOV
Last Name:RAYTCHEV
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 SOUTHCREST DRIVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6117
Mailing Address - Country:US
Mailing Address - Phone:770-996-9945
Mailing Address - Fax:770-996-7355
Practice Address - Street 1:1035 SOUTHCREST DRIVE
Practice Address - Street 2:SUITE 250
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6117
Practice Address - Country:US
Practice Address - Phone:770-996-9945
Practice Address - Fax:770-996-7355
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN213784363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily