Provider Demographics
NPI:1346993979
Name:RAINES, HANNAH ELISABETH (PAC)
Entity type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:ELISABETH
Last Name:RAINES
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:ELISABETH
Other - Last Name:WALDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:1505 NORTHSIDE BLVD STE 2000
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-6205
Mailing Address - Country:US
Mailing Address - Phone:770-781-4010
Mailing Address - Fax:770-781-5334
Practice Address - Street 1:1505 NORTHSIDE BLVD STE 2000
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6205
Practice Address - Country:US
Practice Address - Phone:770-781-4010
Practice Address - Fax:770-781-5334
Is Sole Proprietor?:No
Enumeration Date:2022-02-02
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12376363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant