Provider Demographics
NPI:1992192900
Name:MP RAINES PC
Entity Type:Organization
Organization Name:MP RAINES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:RAINES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-869-9930
Mailing Address - Street 1:PO BOX 7282
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-7282
Mailing Address - Country:US
Mailing Address - Phone:229-869-9930
Mailing Address - Fax:
Practice Address - Street 1:2453 LEE STREET RD
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-9260
Practice Address - Country:US
Practice Address - Phone:229-869-9930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-17
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA35979207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty