Provider Demographics
NPI:1144465147
Name:RAINBOW PEDIATRIC CLINIC, LLC
Entity type:Organization
Organization Name:RAINBOW PEDIATRIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AARTI
Authorized Official - Middle Name:GANJU
Authorized Official - Last Name:RAINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-781-1606
Mailing Address - Street 1:1670 BUFORD HWY
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-6585
Mailing Address - Country:US
Mailing Address - Phone:770-781-1606
Mailing Address - Fax:
Practice Address - Street 1:1670 BUFORD HWY
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6585
Practice Address - Country:US
Practice Address - Phone:770-781-1606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA455912080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty