Provider Demographics
NPI:1144610031
Name:WILLIAMS, RAINEY SELLERS (NP)
Entity Type:Individual
Prefix:
First Name:RAINEY
Middle Name:SELLERS
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-6161
Mailing Address - Country:US
Mailing Address - Phone:229-228-4130
Mailing Address - Fax:229-226-4690
Practice Address - Street 1:951 S BROAD ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6161
Practice Address - Country:US
Practice Address - Phone:229-228-4130
Practice Address - Fax:229-226-4690
Is Sole Proprietor?:No
Enumeration Date:2015-01-29
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN208930363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003158943AMedicaid