MEDICARE: DR. JAMMIE NOEL RAINEY PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	2514	NC
2	103TC2200X	Clinical Child & Adolescent Psychologist	2514	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D1402	OTHER	NC	MEDCOST PROVIDER #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	045JG	OTHER	NC	BCBS

General Provider Information

NPI Number	:	1528191533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMMIE NOEL RAINEY PH.D.

Provider Business Mailing Address
First Line	:	7310 MIDDLEBURY PL
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28212-4721
Country	:	US
Telephone Number	:	704-532-8438
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 BRIAR CREEK ROAD
Second Line	:	SUITE BB-400 THE PARK EXPO & CONFERENCE CENTER
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-6903
Country	:	US
Telephone Number	:	704-408-3703
Fax Number	:	704-537-9356

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	08/09/2012

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