Healthcare Provider Details

I. General information

NPI: 1417902552
Provider Name (Legal Business Name): LAWRENCE MERIAL RAINES III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 01/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 S.E. MAYNARD RD SUITE 204
CARY NC
27511-6944
US

IV. Provider business mailing address

P.O. BOX 3153
CARY NC
27519-3153
US

V. Phone/Fax

Practice location:
  • Phone: 919-462-1558
  • Fax: 888-804-9673
Mailing address:
  • Phone: 919-462-1558
  • Fax: 888-804-9673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number9401309
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number9401309
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number9401309
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: