Provider Demographics
NPI:1740394428
Name:RABER, PAUL EDWARD (DO)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:EDWARD
Last Name:RABER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 209
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:GA
Mailing Address - Zip Code:30650-0209
Mailing Address - Country:US
Mailing Address - Phone:706-752-0322
Mailing Address - Fax:978-327-7921
Practice Address - Street 1:1550 EATONTON RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:GA
Practice Address - Zip Code:30650-4627
Practice Address - Country:US
Practice Address - Phone:706-752-0322
Practice Address - Fax:978-327-7921
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042704207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000739252KMedicaid