Provider Demographics
NPI:1295741460
Name:MCKOY, RAYMOND CAMPBELL (DO)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:CAMPBELL
Last Name:MCKOY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 W 10TH ST NE
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-2639
Mailing Address - Country:US
Mailing Address - Phone:706-802-8400
Mailing Address - Fax:706-622-2890
Practice Address - Street 1:310 W 10TH ST NE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2639
Practice Address - Country:US
Practice Address - Phone:706-802-8400
Practice Address - Fax:706-622-2890
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044532207QA0401X, 207R00000X, 207RA0401X, 207RH0002X
GA044536207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000757754LMedicaid
GAP00417342OtherRR MEDICARE
GAP00344049OtherRR MEDICARE
G58772Medicare UPIN
GA000757754LMedicaid
GA11SCHSCMedicare PIN