Provider Demographics
NPI:1336372804
Name:RAY, RHONDA L
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:L
Last Name:RAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 W BLACKWELL ST
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-3395
Mailing Address - Country:US
Mailing Address - Phone:931-461-0290
Mailing Address - Fax:931-461-0209
Practice Address - Street 1:207 W BLACKWELL ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-3395
Practice Address - Country:US
Practice Address - Phone:931-461-0290
Practice Address - Fax:931-461-0209
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility