Individual
RAE RILEY DEWOODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A-C
Contact information
Practice address
2801 DEKALB MEDICAL PKWY, LITHONIA, GA 30058-4996
(404) 501-8700
Mailing address
2100 POWELL ST, STE 920, EMERYVILLE, CA 94608-1826
(510) 350-2777
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
002645
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100001061B
—
GA
05
—
100001061C
—
GA
05
—
100001061D
—
GA
Enumeration date
06/16/2006
Last updated
01/07/2022
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