Provider Demographics
NPI:1912513565
Name:RANKINS, WILLIAM RAY
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RAY
Last Name:RANKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3627 DORNOCH DR APT D
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-9300
Mailing Address - Country:US
Mailing Address - Phone:910-273-8704
Mailing Address - Fax:910-779-0367
Practice Address - Street 1:3627 DORNOCH DR APT D
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-9300
Practice Address - Country:US
Practice Address - Phone:910-273-8704
Practice Address - Fax:910-779-0367
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC004569OtherVA
004569OtherVETERANS ADMINISTRATION