Provider Demographics
NPI:1710796578
Name:PREAVY, MARY RAE
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:RAE
Last Name:PREAVY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 LEE ROAD 344
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:AL
Mailing Address - Zip Code:36874-3822
Mailing Address - Country:US
Mailing Address - Phone:334-441-5061
Mailing Address - Fax:
Practice Address - Street 1:3501 MASSEE LN STE D
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-2658
Practice Address - Country:US
Practice Address - Phone:762-524-7470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN264808363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily