Provider Demographics
NPI:1104871326
Name:RAY, J. WARNER (MD)
Entity type:Individual
Prefix:
First Name:J. WARNER
Middle Name:
Last Name:RAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 PROFESSIONAL CT
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2531
Mailing Address - Country:US
Mailing Address - Phone:770-997-8424
Mailing Address - Fax:
Practice Address - Street 1:255 PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2531
Practice Address - Country:US
Practice Address - Phone:770-997-8424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA114532085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00082156BMedicaid
GA150157OtherBLUE CROSS/BLUE SHIELD
GA276930OtherBLUE CROSS/ BLUE SHIELD
GA00082156EMedicaid
GA00082156DMedicaid
GA2406495OtherUNITED HEALTHCARE
GA00082156AMedicaid
GA00082156CMedicaid
GA022055OtherBLUE CROSS/ BLUE SHIELD
GA30BDCBVMedicare ID - Type Unspecified
GA00082156CMedicaid
GA150157OtherBLUE CROSS/BLUE SHIELD
GA2406495OtherUNITED HEALTHCARE
GA022055OtherBLUE CROSS/ BLUE SHIELD
GA30CDBTTMedicare ID - Type Unspecified