Jackson Patten Rainer, PH.D.

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

License

1142 Issued in GA

Practice address

3103 Clairmont Rd NE Ste B
Brookhaven, GA 30329-1043

Phone

(404) 636-1457

Fax

(404) 636-7449

NPI assigned

Jun 27, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Oct 1, 2024 through Oct 1, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Michael Pitts, Psy.D., P.C.

  • Clinical Psychologist
  • Roswell, GA
  • NPI 1124143763
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634083200000",
    "number": "1457388019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1017 FAYETTEVILLE RD SE STE A",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303162932",
            "telephone_number": "404-636-1457",
            "fax_number": "404-636-7449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3103 CLAIRMONT RD NE STE B",
            "city": "BROOKHAVEN",
            "state": "GA",
            "postal_code": "303291043",
            "telephone_number": "404-636-1457",
            "fax_number": "404-636-7449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAINER",
        "first_name": "JACKSON",
        "middle_name": "PATTEN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-27",
        "last_updated": "2021-10-13",
        "certification_date": "2021-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "GA",
            "license": "1142",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "202G704720",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Juliana Pyles, RBT
• Missy M Quach
• Haley Leigh Quinlan, DPT
• Mariam Qureshi, M.D.
• R&C Holdings Inc
• Nigeria Rainey, RBT
• Andrea Rainoff, DMD
• Reanna Ramasami, RBT
• Jswanda Vanae Rankins, M.S. CCC/SLP
• Vindhya Rao, DO

• Counseling Psychologist in Brookhaven, GA
• Providers in Brookhaven, GA by specialty
• Counseling Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.