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General NPI Number Information
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NPI Number | 1144215872
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Entity Type | Individual
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Provider Name | MICHAEL P RAINES M.D
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Gender | Male
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Dates
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Enumeration Date | 09/19/2005
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Last Update Date | 11/21/2011
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Provider Practice Location Address
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Address Line | 122 HIGHWAY 280 SUITE A
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City | AMERICUS
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State | GA
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Zip | 31719-8645
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Country | US
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Telephone | 229-931-7156
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Fax | 229-931-9472
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Provider Business Mailing Address
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Address Line | PO BOX 827
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City | AMERICUS
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State | GA
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Zip | 31709-0827
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Country | US
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Telephone | 229-931-7156
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Fax | 229-931-9472
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 035979
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License Number State | GA
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