MEDICARE: DR. JUDITH T RAUSCH M.D.

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	207Q00000X	Family Medicine Physician	019757	GA

General Provider Information

NPI Number	:	1841216447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDITH T RAUSCH M.D.

Provider Business Mailing Address
First Line	:	1000 WYNGATE PKWY
Second Line	:	SUITE 210
City	:	WOODSTOCK
State	:	GA
Zip	:	30189-6981
Country	:	US
Telephone Number	:	678-384-7305
Fax Number	:	770-928-9109

Provider Business Practice Location Address
First Line	:	1000 WYNGATE PKWY
Second Line	:	SUITE 210
City	:	WOODSTOCK
State	:	GA
Zip	:	30189-6981
Country	:	US
Telephone Number	:	678-384-7305
Fax Number	:	770-928-9109

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

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	07/09/2013

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