Individual
RAYLLENSONS ITACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
2020 CUMMING HIGHWAY, SUITE 102, CANTON, GA 30115
(678) 593-1295
(678) 593-1294
Mailing address
550 PEACHTREE ST NE, SUITE 1600, ATLANTA, GA 30308-2212
(404) 881-1094
(404) 874-1249
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
006147
GA
Other
Enumeration date
09/09/2011
Last updated
04/05/2016
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