Provider Demographics
NPI:1982494845
Name:RAINES, PHIL III (PSYD)
Entity type:Individual
Prefix:DR
First Name:PHIL
Middle Name:
Last Name:RAINES
Suffix:III
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 VILLA SPRING CT
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-2277
Mailing Address - Country:US
Mailing Address - Phone:678-488-0662
Mailing Address - Fax:
Practice Address - Street 1:1975 VILLA SPRING CT
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-2277
Practice Address - Country:US
Practice Address - Phone:470-342-7557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-12
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2414103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical