Individual
RAVEN WEST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
720 WESTVIEW DR SW, ATLANTA, GA 30310-1458
(615) 738-7516
Mailing address
763 PLANTATION WAY, GALLATIN, TN 37066-7495
(615) 738-7516
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
363A00000X
Physician Assistant
Primary
12956
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/05/2023
Last updated
03/25/2025
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