Provider Demographics
NPI:1578587176
Name:RAINEY, RHETT K (DO)
Entity Type:Individual
Prefix:
First Name:RHETT
Middle Name:K
Last Name:RAINEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-2155
Mailing Address - Country:US
Mailing Address - Phone:770-867-2120
Mailing Address - Fax:770-867-2140
Practice Address - Street 1:314 NORTH BROAD STREET
Practice Address - Street 2:SUITE 340
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680
Practice Address - Country:US
Practice Address - Phone:770-867-2120
Practice Address - Fax:770-867-2140
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050830207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00935492AMedicaid
GA20BBFP2Medicare ID - Type Unspecified
D24902Medicare UPIN