MEDICARE: RAUSHANAH HUD-ALEEM D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	062999	GA

General Provider Information

NPI Number	:	1194924662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAUSHANAH HUD-ALEEM D.O.

Provider Business Mailing Address
First Line	:	705 CARNABY CT
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-2941
Country	:	US
Telephone Number	:	404-692-1801
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 WYNNTON RD STE 102
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31906-5705
Country	:	US
Telephone Number	:	404-692-1801
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2007
Last Update Date	:	08/20/2024

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