MEDICARE: DR. SHANNON ROBERT RAINEY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	058764	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265406904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANNON ROBERT RAINEY M.D.

Provider Business Mailing Address
First Line	:	934 NAPIERS POST DR
Second Line	:
City	:	EVANS
State	:	GA
Zip	:	30809
Country	:	US
Telephone Number	:	706-860-7593
Fax Number	:

Provider Business Practice Location Address
First Line	:	3651 WHEELER RD
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-6521
Country	:	US
Telephone Number	:	210-846-0726
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2006
Last Update Date	:	02/06/2020

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