1528191533 NPI number — DR. JAMMIE NOEL RAINEY PH.D.

Table of content: DR. JAMMIE NOEL RAINEY PH.D. (NPI 1528191533)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528191533 NPI number — DR. JAMMIE NOEL RAINEY PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAINEY
Provider First Name:
JAMMIE
Provider Middle Name:
NOEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528191533
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7310 MIDDLEBURY PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28212-4721
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-532-8438
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 BRIAR CREEK ROAD
Provider Second Line Business Practice Location Address:
SUITE BB-400 THE PARK EXPO & CONFERENCE CENTER
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28205-6903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-408-3703
Provider Business Practice Location Address Fax Number:
704-537-9356
Provider Enumeration Date:
03/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  2514 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC2200X , with the licence number: 2514 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: D1402 . This is a "MEDCOST PROVIDER #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 6000469 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 045JG . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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