Provider Demographics
NPI:1396923520
Name:RAYBURN, MICHAEL W (PA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:RAYBURN
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Gender:M
Credentials:PA
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Mailing Address - Street 1:3400 OLD MILTON PKWY # C
Mailing Address - Street 2:SUITE 425
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-3707
Mailing Address - Country:US
Mailing Address - Phone:770-343-8760
Mailing Address - Fax:770-664-2101
Practice Address - Street 1:3400 OLD MILTON PKWY # C
Practice Address - Street 2:SUITE 425
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3707
Practice Address - Country:US
Practice Address - Phone:770-343-8760
Practice Address - Fax:770-664-2101
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2016-12-02
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Provider Licenses
StateLicense IDTaxonomies
GA005193363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant