Provider Demographics
NPI:1124355086
Name:RAY, LAURA ASHLEY (MD)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ASHLEY
Last Name:RAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:ASHLEY
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3320 OLD JEFFERSON RD BLDG 700
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30607-1465
Mailing Address - Country:US
Mailing Address - Phone:706-353-2990
Mailing Address - Fax:706-353-2992
Practice Address - Street 1:658 N. CHASE STREET, STE 201
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30607
Practice Address - Country:US
Practice Address - Phone:706-353-2990
Practice Address - Fax:706-353-2992
Is Sole Proprietor?:No
Enumeration Date:2009-11-12
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR7305208600000X
390200000X
GA82910208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003231626MMedicaid