Provider Demographics
NPI:1649744897
Name:J RAPHA HEALTHCARE SERVICES INC
Entity type:Organization
Organization Name:J RAPHA HEALTHCARE SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EKEI
Authorized Official - Middle Name:JOSO
Authorized Official - Last Name:TANIFUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-445-5520
Mailing Address - Street 1:100 TIMBER TRAIL RD STE 104
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-9416
Mailing Address - Country:US
Mailing Address - Phone:912-445-5520
Mailing Address - Fax:
Practice Address - Street 1:100 TIMBER TRAIL RD STE 104
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-9416
Practice Address - Country:US
Practice Address - Phone:912-445-5520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-21
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty