Provider Demographics
NPI:1952640518
Name:RABORN, LEWIS ALLEN JR
Entity Type:Individual
Prefix:MR
First Name:LEWIS
Middle Name:ALLEN
Last Name:RABORN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4757 REMINGTON PL
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-1279
Mailing Address - Country:US
Mailing Address - Phone:706-799-7884
Mailing Address - Fax:
Practice Address - Street 1:4757 REMINGTON PL
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-1279
Practice Address - Country:US
Practice Address - Phone:706-799-7884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies