Provider Demographics
NPI:1699831750
Name:RAY, DAVID A (RPT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:RAY
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 ADMIRALTY WAY NW
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-9071
Mailing Address - Country:US
Mailing Address - Phone:478-453-9522
Mailing Address - Fax:
Practice Address - Street 1:200 S TALLAHASSEE ST
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:GA
Practice Address - Zip Code:31539-6024
Practice Address - Country:US
Practice Address - Phone:912-375-7009
Practice Address - Fax:912-375-7055
Is Sole Proprietor?:No
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA001265225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA116804Medicare ID - Type Unspecified