Provider Demographics
NPI:1629321468
Name:LUTHRA, RAINA (PA-C)
Entity Type:Individual
Prefix:
First Name:RAINA
Middle Name:
Last Name:LUTHRA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 W BOBO NEWSOM HWY
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-4710
Mailing Address - Country:US
Mailing Address - Phone:843-339-2100
Mailing Address - Fax:
Practice Address - Street 1:1110 W PEACHTREE ST NW STE 200A
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3609
Practice Address - Country:US
Practice Address - Phone:404-575-2000
Practice Address - Fax:404-575-2001
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-03812363A00000X
GA9656363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant