Provider Demographics
NPI:1104285212
Name:LAYMAN, MARY RACHEL (PA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:RACHEL
Last Name:LAYMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12938
Mailing Address - Street 2:C/O CLINIC MANAGEMENT
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30703-7013
Mailing Address - Country:US
Mailing Address - Phone:706-602-7800
Mailing Address - Fax:
Practice Address - Street 1:100 HOSPITAL CT
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-2077
Practice Address - Country:US
Practice Address - Phone:706-602-8200
Practice Address - Fax:706-602-1354
Is Sole Proprietor?:No
Enumeration Date:2016-02-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7887363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003180927AMedicaid
GAGRP4720OtherGRP #
GA20297I3681OtherMEDICARE PTAN