Provider Demographics
NPI:1821748062
Name:RAYMOND, SIDEANA (MD)
Entity Type:Individual
Prefix:
First Name:SIDEANA
Middle Name:
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 N HOUSTON RD STE 140E
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-3023
Mailing Address - Country:US
Mailing Address - Phone:478-975-6880
Mailing Address - Fax:478-975-6869
Practice Address - Street 1:233 N HOUSTON RD STE 140E
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3023
Practice Address - Country:US
Practice Address - Phone:478-975-6880
Practice Address - Fax:478-975-6869
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program