Provider Demographics
NPI:1518553692
Name:RAINEY, SARAH ELIZABETH (CPNP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ELIZABETH
Last Name:RAINEY
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1062 FORSYTH ST STE 2D
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-8639
Mailing Address - Country:US
Mailing Address - Phone:478-633-8391
Mailing Address - Fax:478-338-3956
Practice Address - Street 1:1062 FORSYTH ST STE 2D
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-8639
Practice Address - Country:US
Practice Address - Phone:478-633-8391
Practice Address - Fax:478-338-3956
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN223141363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics