Healthcare Provider Details

I. General information

NPI: 1194761023
Provider Name (Legal Business Name): NORMA CLAIR RAINS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 CLAIRMONT RD
DECATUR GA
30033-4004
US

IV. Provider business mailing address

10665 THATCHER WAY
DULUTH GA
30097-5709
US

V. Phone/Fax

Practice location:
  • Phone: 404-321-6111
  • Fax: 404-327-4957
Mailing address:
  • Phone: 770-740-9102
  • Fax: 404-327-4957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208U00000X
TaxonomyClinical Pharmacology Physician
License NumberAL6023
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: