Provider Demographics
NPI:1467707943
Name:RAINEY, KELLY Y
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:Y
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 1:2421 SANTA BARBRA CT SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-2006
Mailing Address - Country:US
Mailing Address - Phone:678-598-8120
Mailing Address - Fax:888-316-5037
Practice Address - Street 1:2421 SANTA BARBRA CT SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-2006
Practice Address - Country:US
Practice Address - Phone:678-598-8120
Practice Address - Fax:888-316-5037
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA72810343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)