MEDICARE: MRS. MIRANDA RUTLAND NP

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	163WC0200X	Critical Care Medicine Registered Nurse	RN288428	GA
2	363L00000X	Nurse Practitioner	RN288428	GA
3	363LC0200X	Critical Care Medicine Nurse Practitioner	RN288428	GA

General Provider Information

NPI Number	:	1881330827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MIRANDA RUTLAND NP

Provider Business Mailing Address
First Line	:	210 EXECUTIVE DR.
Second Line	:
City	:	CARROLLTON
State	:	GA
Zip	:	30117
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1968 PEACHTREE RD NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-1281
Country	:	US
Telephone Number	:	404-605-5000
Fax Number	:

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

Provider Enumeration Date	:	05/11/2022
Last Update Date	:	01/14/2026

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