Individual
DR. JACKSON PATTEN RAINER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
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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