Provider Demographics
NPI:1629819362
Name:GAINES, RENDARRIS T
Entity type:Individual
Prefix:
First Name:RENDARRIS
Middle Name:T
Last Name:GAINES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 SCENIC VIEW CT
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3684
Mailing Address - Country:US
Mailing Address - Phone:706-371-0482
Mailing Address - Fax:
Practice Address - Street 1:635 SCENIC VIEW CT
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-3684
Practice Address - Country:US
Practice Address - Phone:706-371-0482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician