Basic Information
| Provider Information | |||||||||
| NPI: | 1366584500 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOWELL | ||||||||
| FirstName: | RAY | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD,MBA,FACOG,FICS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 818 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | GA | ||||||||
| PostalCode: | 313290818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9127540380 | ||||||||
| FaxNumber: | 9127541250 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 GOSHEN RD | ||||||||
| Address2: | |||||||||
| City: | RINCON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 313265744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9128265239 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2007 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | 034161 | GA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 034161 | 01 | GA | LICENSE | OTHER | 00470874B | 05 | GA | MEDICAID |