MEDICARE: DR. DIANE RAINFORD PMHNP-BC, WHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN196645	GA
2	363LW0102X	Women's Health Nurse Practitioner	RN196645	GA

General Provider Information

NPI Number	:	1912325267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANE RAINFORD PMHNP-BC, WHNP-BC

Provider Business Mailing Address
First Line	:	1700 NORTHSIDE DRIVE
Second Line	:	SUITE A7, #2133
City	:	ATLANTA
State	:	GA
Zip	:	30318-2695
Country	:	US
Telephone Number	:	470-957-8477
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 NORTHSIDE DR NW STE A7
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-2695
Country	:	US
Telephone Number	:	470-957-8477
Fax Number	:

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

Provider Enumeration Date	:	04/03/2014
Last Update Date	:	08/27/2024

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