Individual
DR. JACKSON PATTEN RAINER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
3103 CLAIRMONT RD NE STE B, BROOKHAVEN, GA 30329-1043
(404) 636-1457
(404) 636-7449
Mailing address
1017 FAYETTEVILLE RD SE STE A, ATLANTA, GA 30316-2932
(404) 636-1457
(404) 636-7449
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
1142
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202G704720
PTAN
GA
Enumeration date
06/27/2006
Last updated
10/13/2021
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