Healthcare Provider Details

I. General information

NPI: 1881878585
Provider Name (Legal Business Name): RHETT K. RAINEY, D. O.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2007
Last Update Date: 01/05/2025
Certification Date: 01/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 W ATHENS ST STE I
WINDER GA
30680-1785
US

IV. Provider business mailing address

PO BOX 1394
WINDER GA
30680-1394
US

V. Phone/Fax

Practice location:
  • Phone: 770-867-2120
  • Fax: 770-867-2140
Mailing address:
  • Phone: 770-867-2120
  • Fax: 770-867-2140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number050830
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ROXANNE ROBERTS
Title or Position: MANAGER
Credential:
Phone: 770-867-2120