Provider Demographics
NPI:1285749788
Name:MURRAIN, LUIS ALBERTO (DO)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ALBERTO
Last Name:MURRAIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:BLAKELY
Mailing Address - State:GA
Mailing Address - Zip Code:39823-2554
Mailing Address - Country:US
Mailing Address - Phone:229-723-2660
Mailing Address - Fax:229-723-2663
Practice Address - Street 1:360 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BLAKELY
Practice Address - State:GA
Practice Address - Zip Code:39823-2554
Practice Address - Country:US
Practice Address - Phone:229-723-2660
Practice Address - Fax:229-723-2663
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057747207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA024893266AMedicaid
GA024893266AMedicaid
GA08CBCGGMedicare PIN
GA111893Medicare ID - Type UnspecifiedPRIMARY CARE OF SWGA