Provider Demographics
NPI:1144257379
Name:RAY, KARRI O (PA-C)
Entity type:Individual
Prefix:
First Name:KARRI
Middle Name:O
Last Name:RAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1497 FAIR RD STE 102
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-0823
Mailing Address - Country:US
Mailing Address - Phone:912-486-1600
Mailing Address - Fax:912-871-3342
Practice Address - Street 1:1497 FAIR RD STE 102
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458
Practice Address - Country:US
Practice Address - Phone:912-486-1600
Practice Address - Fax:912-871-3324
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004109363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA877965428CMedicaid
GAGRP1372Medicaid
GAP00316602OtherRR MEDICARE