Provider Demographics
NPI:1881878585
Name:RHETT K. RAINEY, D. O.
Entity type:Organization
Organization Name:RHETT K. RAINEY, D. O.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-867-2120
Mailing Address - Street 1:PO BOX 1394
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-1394
Mailing Address - Country:US
Mailing Address - Phone:770-867-2120
Mailing Address - Fax:770-867-2140
Practice Address - Street 1:133 W ATHENS ST STE I
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-1785
Practice Address - Country:US
Practice Address - Phone:770-867-2120
Practice Address - Fax:770-867-2140
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RHETT K. RAINEY, D.O.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-18
Last Update Date:2025-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
GA050830207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00935492AMedicaid
GAD24902Medicare UPIN
GA00935492AMedicaid