Provider Demographics
NPI:1184373623
Name:RAYBORN, KARYE (RD, LD, IBCLC)
Entity type:Individual
Prefix:
First Name:KARYE
Middle Name:
Last Name:RAYBORN
Suffix:
Gender:F
Credentials:RD, LD, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 VETERANS PKWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-9001
Mailing Address - Country:US
Mailing Address - Phone:706-321-6215
Mailing Address - Fax:706-321-6295
Practice Address - Street 1:5601 VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-9001
Practice Address - Country:US
Practice Address - Phone:706-321-6215
Practice Address - Fax:706-321-6295
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD006118133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered