Provider Demographics
NPI:1972668200
Name:RAINWATER, GREGORY TODD (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:TODD
Last Name:RAINWATER
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 1:1020 J L WHITE DR
Mailing Address - Street 2:SUITE 170
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-4908
Mailing Address - Country:US
Mailing Address - Phone:706-692-2437
Mailing Address - Fax:
Practice Address - Street 1:1020 J L WHITE DR
Practice Address - Street 2:SUITE 170
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-4908
Practice Address - Country:US
Practice Address - Phone:706-692-2437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039444207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA08BDNBGMedicare ID - Type Unspecified
GA000639889DMedicaid
F95990Medicare UPIN