Individual
J. WARNER RAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
255 PROFESSIONAL CT, RIVERDALE, GA 30274-2531
(770) 997-8424
Mailing address
255 PROFESSIONAL CT, RIVERDALE, GA 30274-2531
(770) 997-8424
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
11453
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00082156A
—
GA
05
—
00082156B
—
GA
05
—
00082156C
—
GA
05
—
00082156D
—
GA
05
—
00082156E
—
GA
01
—
022055
BLUE CROSS/ BLUE SHIELD
GA
01
—
150157
BLUE CROSS/BLUE SHIELD
GA
01
—
2406495
UNITED HEALTHCARE
GA
01
—
276930
BLUE CROSS/ BLUE SHIELD
GA
Enumeration date
05/24/2006
Last updated
07/08/2007
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