Provider Demographics
NPI:1003580200
Name:RAINEY, CAMILLE (CNA)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:RAINEY
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5717 TWAIN DR
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-3937
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5717 TWAIN DR
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-3937
Practice Address - Country:US
Practice Address - Phone:678-558-2586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0008554435311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)