Provider Demographics
NPI:1194419614
Name:WILLIS, RALYN MCCLAY (PA-C)
Entity type:Individual
Prefix:
First Name:RALYN
Middle Name:MCCLAY
Last Name:WILLIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:334 DEESE RD
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39817-7421
Mailing Address - Country:US
Mailing Address - Phone:229-220-9807
Mailing Address - Fax:
Practice Address - Street 1:1156 NASHVILLE PIKE
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-3110
Practice Address - Country:US
Practice Address - Phone:615-989-1088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical