Individual
MR. RAYMOND EUGENE POLK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
134 ANSLEY DR STE 400, DAHLONEGA, GA 30533-1642
(706) 864-1580
(770) 219-9561
Mailing address
PO BOX 742616, ATLANTA, GA 30374-2616
(770) 219-8420
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
002539
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100000066A
—
GA
Enumeration date
08/11/2005
Last updated
01/21/2021
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