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General NPI Number Information
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NPI Number | 1760467005
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Entity Type | Individual
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Provider Name | RAINE WILLIAM PENDARVIS M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/09/2005
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | 3107 WATSONS BND
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City | ALPHARETTA
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State | GA
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Zip | 30004-8825
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Country | US
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Telephone | 678-691-0487
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Fax | 678-691-0487
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Provider Business Mailing Address
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Address Line | 3107 WATSONS BND
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City | ALPHARETTA
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State | GA
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Zip | 30004-8825
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Country | US
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Telephone | 678-691-0487
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Fax |
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 15628
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 036110696
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME84545
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 24145
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License Number State | OK
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Taxonomy #5
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 046803
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License Number State | GA
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