Provider Demographics
NPI:1720029861
Name:RAY, LARRY GRAYDON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:GRAYDON
Last Name:RAY
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:2801 N DECATUR RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5949
Mailing Address - Country:US
Mailing Address - Phone:404-296-3111
Mailing Address - Fax:678-686-9522
Practice Address - Street 1:2801 N DECATUR RD
Practice Address - Street 2:SUITE 300
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5949
Practice Address - Country:US
Practice Address - Phone:404-296-3111
Practice Address - Fax:678-686-9522
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2012-05-24
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Provider Licenses
StateLicense IDTaxonomies
GA39446207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA39446OtherSTATE MEDICAL LICENSE #
GA39446OtherSTATE MEDICAL LICENSE #