Provider Demographics
NPI:1548010325
Name:RAY, KRISTAL
Entity type:Individual
Prefix:
First Name:KRISTAL
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTAL
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PBT CMA
Mailing Address - Street 1:PO BOX 398
Mailing Address - Street 2:
Mailing Address - City:REDAN
Mailing Address - State:GA
Mailing Address - Zip Code:30074-0398
Mailing Address - Country:US
Mailing Address - Phone:915-202-1449
Mailing Address - Fax:
Practice Address - Street 1:4052 LAWRENCEVILLE HWY
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4621
Practice Address - Country:US
Practice Address - Phone:770-609-6068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach