Provider Demographics
NPI:1174804702
Name:ITACY, RAYLLENSONS (PA)
Entity type:Individual
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First Name:RAYLLENSONS
Middle Name:
Last Name:ITACY
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Gender:F
Credentials:PA
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Mailing Address - Street 1:550 PEACHTREE ST NE
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2212
Mailing Address - Country:US
Mailing Address - Phone:404-881-1094
Mailing Address - Fax:404-874-1249
Practice Address - Street 1:2020 CUMMING HIGHWAY
Practice Address - Street 2:SUITE 102
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115
Practice Address - Country:US
Practice Address - Phone:678-593-1295
Practice Address - Fax:678-593-1294
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2016-04-05
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Provider Licenses
StateLicense IDTaxonomies
GA006147363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant