Provider Demographics
NPI:1588913404
Name:RAINWATER, ASHLEY (RD, LD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:RAINWATER
Suffix:
Gender:F
Credentials:RD, LD
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 31258
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30903-3058
Mailing Address - Country:US
Mailing Address - Phone:706-774-7365
Mailing Address - Fax:706-828-2389
Practice Address - Street 1:1350 WALTON WAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2612
Practice Address - Country:US
Practice Address - Phone:706-288-3080
Practice Address - Fax:706-868-3240
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD003949133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered