Provider Demographics
NPI:1891787586
Name:RANIERE,JR, JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:RANIERE,JR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:874 W LANIER AVE
Mailing Address - Street 2:ONE PRESTIGE PARK SUITE 100
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1511
Mailing Address - Country:US
Mailing Address - Phone:770-461-4000
Mailing Address - Fax:770-461-2790
Practice Address - Street 1:874 W LANIER AVE
Practice Address - Street 2:ONE PRESTIGE PARK SUITE 100
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1511
Practice Address - Country:US
Practice Address - Phone:770-461-4000
Practice Address - Fax:770-461-2790
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048705208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00874387AMedicaid
GA24BCBRMMedicare ID - Type Unspecified
GA00874387AMedicaid