Provider Demographics
NPI:1366584500
Name:HOWELL, RAY L (MD,MBA,FACOG,FICS)
Entity type:Individual
Prefix:
First Name:RAY
Middle Name:L
Last Name:HOWELL
Suffix:
Gender:M
Credentials:MD,MBA,FACOG,FICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 818
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:GA
Mailing Address - Zip Code:31329-0818
Mailing Address - Country:US
Mailing Address - Phone:912-754-0380
Mailing Address - Fax:912-754-1250
Practice Address - Street 1:110 GOSHEN RD
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-5744
Practice Address - Country:US
Practice Address - Phone:912-826-5239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034161207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA034161OtherLICENSE
GA00470874BMedicaid
GAF11127Medicare UPIN
16BDDQPMedicare ID - Type Unspecified