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NPI Code Detail

MEDICARE: DR. GREGORY RUSIECKI DO

MEDICARE: DR. GREGORY RUSIECKI DO
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
1207Q00000XFamily Medicine Physician97133GA
2390200000XStudent in an Organized Health Care Education/Training Program12024GA

General Provider Information

NPI Number : 1982229175
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GREGORY RUSIECKI DO
Provider Business Mailing Address
First Line : 304 TURNER MCCALL BLVD SW
Second Line :
City : ROME
State : GA
Zip : 30165-5621
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 123 THREE RIVERS DR NE
Second Line :
City : ROME
State : GA
Zip : 30161-2300
Country : US
Telephone Number : 706-295-3961
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2020
Last Update Date : 09/29/2023

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