Provider Demographics
NPI:1144215872
Name:RAINES, MICHAEL P (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:RAINES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 827
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-0827
Mailing Address - Country:US
Mailing Address - Phone:229-931-7156
Mailing Address - Fax:229-931-9472
Practice Address - Street 1:122 HIGHWAY 280
Practice Address - Street 2:SUITE A
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31719-8645
Practice Address - Country:US
Practice Address - Phone:229-931-7156
Practice Address - Fax:229-931-9472
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035979207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000505656GMedicaid
GAP00226677OtherRR MEDICARE PROVIDER #
GA08BBRNLMedicare PIN
GAP00226677OtherRR MEDICARE PROVIDER #