Provider Demographics
NPI:1972761732
Name:RAYNER, HANSEL M (PA-C)
Entity Type:Individual
Prefix:
First Name:HANSEL
Middle Name:M
Last Name:RAYNER
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:145 EAGLES WALK
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7340
Mailing Address - Country:US
Mailing Address - Phone:770-914-1808
Mailing Address - Fax:770-914-6828
Practice Address - Street 1:145 EAGLES WALK
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7340
Practice Address - Country:US
Practice Address - Phone:770-914-1808
Practice Address - Fax:770-914-6828
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2019-11-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA9542363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant