Provider Demographics
NPI:1790851699
Name:MCRAE, SYLVESTER (MD)
Entity Type:Individual
Prefix:
First Name:SYLVESTER
Middle Name:
Last Name:MCRAE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 MANCHESTER EXPY
Mailing Address - Street 2:STE A002
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-6805
Mailing Address - Country:US
Mailing Address - Phone:706-576-4648
Mailing Address - Fax:706-576-4650
Practice Address - Street 1:2300 MANCHESTER EXPY
Practice Address - Street 2:STE A002
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6805
Practice Address - Country:US
Practice Address - Phone:706-576-4648
Practice Address - Fax:706-576-4650
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA26893207V00000X
AL0012555207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00309306AMedicaid
D30208Medicare UPIN