Healthcare Provider Details

I. General information

NPI: 1700869146
Provider Name (Legal Business Name): AVIE JAMES RAINWATER III PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 06/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

549 W EVANS ST
FLORENCE SC
29501-3487
US

IV. Provider business mailing address

549 W EVANS ST PO BOX 4131
FLORENCE SC
29502-4131
US

V. Phone/Fax

Practice location:
  • Phone: 843-667-4949
  • Fax: 843-667-3349
Mailing address:
  • Phone: 843-667-4949
  • Fax: 843-667-3349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number489
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: