Provider Demographics
NPI:1326754201
Name:RAINEY, ERICCA SHEREE
Entity Type:Individual
Prefix:
First Name:ERICCA
Middle Name:SHEREE
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 1:300 SLEEPY HOLLOW RD LOT 58
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31535-3051
Mailing Address - Country:US
Mailing Address - Phone:912-515-9021
Mailing Address - Fax:
Practice Address - Street 1:300 SLEEPY HOLLOW RD LOT 58
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31535-3051
Practice Address - Country:US
Practice Address - Phone:912-515-9021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor