Provider Demographics
NPI:1952336513
Name:RAINEY, DEBRA L (MD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:L
Last Name:RAINEY
Suffix:
Gender:F
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:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38302-0400
Mailing Address - Country:US
Mailing Address - Phone:731-425-0213
Mailing Address - Fax:731-422-0409
Practice Address - Street 1:2863 HIGHWAY 45 BYP
Practice Address - Street 2:STE 300
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3618
Practice Address - Country:US
Practice Address - Phone:731-422-0213
Practice Address - Fax:731-422-0471
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN25306207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00865697OtherRAILROAD MEDICARE
TN3096129Medicaid
TN103I114356Medicare PIN