Individual
WALTER SHANNON RAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
100 DOCTORS DR, STE 103, DOUGLAS, GA 31533-2210
(912) 383-9789
(912) 383-9435
Mailing address
100 DOCTORS DR, STE 103, DOUGLAS, GA 31533-2210
(912) 383-9789
(912) 383-9435
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
003211
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100002000A
—
GA
Enumeration date
09/11/2006
Last updated
03/23/2010
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