# CENTRAL GEORGIA ADRENAL AND REPRODUCTIVE ENDOCRINOLOGY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174335145
- **Authorized official:** HANSEL MARK RAYNER PA-C (OWNER)
- **Authorized official phone:** (470) 317-3855

## Contact information

- **Practice address:** 374 RACETRACK RD, MCDONOUGH, GA 30252-1022
- **Practice address phone:** (801) 657-8137
- **Practice address fax:** (801) 657-8137
- **Mailing address:** 121 LIGHTHORSE BLVD, MCDONOUGH, GA 30252-2998
- **Mailing address phone:** (801) 657-8137

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | NULL | Yes |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | — | Yes |
| 261QA0006X | Ambulatory Fertility Facility | — | NULL | — |

## Other

- **Enumeration date:** 01/24/2025
- **Last updated:** 01/24/2025