Provider Demographics
NPI:1629219118
Name:RINER, ULYS RANDALL (PA)
Entity type:Individual
Prefix:MR
First Name:ULYS
Middle Name:RANDALL
Last Name:RINER
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:1061 DOWDY ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-3819
Mailing Address - Country:US
Mailing Address - Phone:706-621-7575
Mailing Address - Fax:833-305-0340
Practice Address - Street 1:855 W BROAD ST STE A
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-2511
Practice Address - Country:US
Practice Address - Phone:706-621-7575
Practice Address - Fax:833-305-0340
Is Sole Proprietor?:No
Enumeration Date:2009-03-13
Last Update Date:2024-12-09
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Provider Licenses
StateLicense IDTaxonomies
GA000207363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1427184654OtherREDDY MEDICAL GROUP, LLC