Basic Information
| Provider Information | |||||||||
| NPI: | 1407091499 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | METHODIUS-RAYFORD | ||||||||
| FirstName: | WALAYA | ||||||||
| MiddleName: | CHIYEM | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | METHODIUS-NGWODO | ||||||||
| OtherFirstName: | WALAYA | ||||||||
| OtherMiddleName: | CHIYEM | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 54888 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303080888 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043509505 | ||||||||
| FaxNumber: | 4043501611 | ||||||||
| Practice Location | |||||||||
| Address1: | 1718 PEACHTREE ST NW | ||||||||
| Address2: | SUITE 360 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303092452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043509505 | ||||||||
| FaxNumber: | 4043501611 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2008 | ||||||||
| LastUpdateDate: | 04/22/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | 061985 | GA | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
No ID Information.