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NPI Code Detail

MEDICARE: RUTLAND FAMILY HEALTHCARE LLC

MEDICARE: RUTLAND FAMILY HEALTHCARE LLC
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
1207R00000XInternal Medicine Physician
2207R00000XInternal Medicine Physician04996GA

General Provider Information

NPI Number : 1366487019
Entity Type Code : Organization
Provider Name (Legal Business Name) : RUTLAND FAMILY HEALTHCARE LLC
Provider Business Mailing Address
First Line : 5569 HOUSTON RD
Second Line :
City : MACON
State : GA
Zip : 31216-5709
Country : US
Telephone Number : 478-781-5065
Fax Number : 478-781-0012
Provider Business Practice Location Address
First Line : 5569 HOUSTON RD
Second Line :
City : MACON
State : GA
Zip : 31216-5709
Country : US
Telephone Number : 478-781-5065
Fax Number : 478-781-0012
Authorized Official
Title or Position : MD/OWNER
Name : MARCUS L SIMMONS
Credential : MD
Telephone Number : 478-781-5065
Provider Enumeration Date : 06/17/2006
Last Update Date : 02/09/2022

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Directions to “RUTLAND FAMILY HEALTHCARE LLC ” Practice Location

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