Provider Demographics
NPI:1174750376
Name:RAGLAND, JEREMY THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:THOMAS
Last Name:RAGLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 SHADOWLAWN RD SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-4326
Mailing Address - Country:US
Mailing Address - Phone:404-312-9771
Mailing Address - Fax:
Practice Address - Street 1:677 CHURCH ST NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1101
Practice Address - Country:US
Practice Address - Phone:404-312-9771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2627532084N0400X
FLME1593362084N0400X
ORMD2217432084N0400X
WAMD615756932084N0400X
TXQ55392084A2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurocritical Care
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153449704OtherMDCD GRP TPI HARRIS CO
TX00106WOtherMDCR GRP PTAN HARRIS CO
TX0035TDOtherBCBSTX GRP PROV #
TXDB6392OtherRR MDCR GRP PTAN