Provider Demographics
NPI:1154778629
Name:STALLINGS, RAYVELLE ANTOINETTE (MD)
Entity type:Individual
Prefix:DR
First Name:RAYVELLE
Middle Name:ANTOINETTE
Last Name:STALLINGS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 JEURGENS CT
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-2219
Mailing Address - Country:US
Mailing Address - Phone:770-279-6200
Mailing Address - Fax:
Practice Address - Street 1:1626 JEURGENS CT
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-2219
Practice Address - Country:US
Practice Address - Phone:816-843-5810
Practice Address - Fax:816-843-6415
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-15
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA410401207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine