Provider Demographics
NPI:1700549664
Name:RAY, ALENE
Entity type:Individual
Prefix:
First Name:ALENE
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 WALTON FERRY RD APT 104
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVLLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-4166
Mailing Address - Country:US
Mailing Address - Phone:615-207-2953
Mailing Address - Fax:615-827-0115
Practice Address - Street 1:430 WALTON FERRY RD APT 104
Practice Address - Street 2:
Practice Address - City:HENDERSONVLLE
Practice Address - State:TN
Practice Address - Zip Code:37075-4166
Practice Address - Country:US
Practice Address - Phone:615-207-2953
Practice Address - Fax:615-827-0115
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
118352982OtherDUNS