MEDICARE: DR. STEPHEN A RUBENDALL JR. 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	057320	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	25806	OTHER	SC	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851345284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN A RUBENDALL JR. M.D.

Provider Business Mailing Address
First Line	:	259 US HIGHWAY 19 NORTH
Second Line	:
City	:	CAMILLA
State	:	GA
Zip	:	31730-1410
Country	:	US
Telephone Number	:	229-336-1949
Fax Number	:	229-336-1436

Provider Business Practice Location Address
First Line	:	259 US HIGHWAY 19 NORTH
Second Line	:
City	:	CAMILLA
State	:	GA
Zip	:	31730-1410
Country	:	US
Telephone Number	:	229-336-1949
Fax Number	:	229-336-1436

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

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	04/10/2019

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