Healthcare Provider Details

I. General information

NPI: 1144215872
Provider Name (Legal Business Name): MICHAEL P RAINES M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 HIGHWAY 280 SUITE A
AMERICUS GA
31719-8645
US

IV. Provider business mailing address

PO BOX 827
AMERICUS GA
31709-0827
US

V. Phone/Fax

Practice location:
  • Phone: 229-931-7156
  • Fax: 229-931-9472
Mailing address:
  • Phone: 229-931-7156
  • Fax: 229-931-9472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number035979
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: