Provider Demographics
NPI:1952452310
Name:BETCHER, RAYMOND EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:EDWARD
Last Name:BETCHER
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 1:770 PINE ST STE 360
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-7591
Mailing Address - Country:US
Mailing Address - Phone:478-633-1821
Mailing Address - Fax:478-633-5180
Practice Address - Street 1:770 PINE ST STE 360
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-7591
Practice Address - Country:US
Practice Address - Phone:478-633-1821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-14
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13880207V00000X
GA92992207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00119528Medicaid
MS00119528Medicaid