Provider Demographics
NPI:1700869146
Name:RAINWATER, AVIE JAMES III (PHD)
Entity Type:Individual
Prefix:DR
First Name:AVIE
Middle Name:JAMES
Last Name:RAINWATER
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 W EVANS ST
Mailing Address - Street 2:PO BOX 4131
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-4131
Mailing Address - Country:US
Mailing Address - Phone:843-667-4949
Mailing Address - Fax:843-667-3349
Practice Address - Street 1:549 W EVANS ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-3487
Practice Address - Country:US
Practice Address - Phone:843-667-4949
Practice Address - Fax:843-667-3349
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC489103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC285004OtherMHN
SCPVPB174618OtherAPS
SCP00199753OtherMETRAHEALTH
SC248101096OtherTRICARE
SCPS0002Medicaid
SCPS0002Medicaid