Provider Demographics
NPI:1487958781
Name:DERRELL W. RAY M.D. P.C.
Entity type:Organization
Organization Name:DERRELL W. RAY M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DERRELL
Authorized Official - Middle Name:W
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-354-4400
Mailing Address - Street 1:8920 EVES RD
Mailing Address - Street 2:P.O. BOX 769179
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-9998
Mailing Address - Country:US
Mailing Address - Phone:912-354-4400
Mailing Address - Fax:912-354-4040
Practice Address - Street 1:340 EISENHOWER DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-1600
Practice Address - Country:US
Practice Address - Phone:912-354-4400
Practice Address - Fax:912-354-4040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty