Provider Demographics
NPI:1194308007
Name:RAINES, TONJA L
Entity type:Individual
Prefix:
First Name:TONJA
Middle Name:L
Last Name:RAINES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1457 JEFFERSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-4370
Mailing Address - Country:US
Mailing Address - Phone:478-321-5771
Mailing Address - Fax:
Practice Address - Street 1:1457 JEFFERSONVILLE RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-4370
Practice Address - Country:US
Practice Address - Phone:478-321-5771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1004242253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care