Provider Demographics
NPI:1255851549
Name:RAINEY, SHAREGAN
Entity Type:Individual
Prefix:
First Name:SHAREGAN
Middle Name:
Last Name:RAINEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 LOCUST ST APT H
Mailing Address - Street 2:
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-3034
Mailing Address - Country:US
Mailing Address - Phone:434-262-2638
Mailing Address - Fax:
Practice Address - Street 1:4751 BEST RD STE 300
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30337-5600
Practice Address - Country:US
Practice Address - Phone:844-856-7907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver