Healthcare Provider Details

I. General information

NPI: 1215764329
Provider Name (Legal Business Name): ZACHARY JAMES RUSH CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2024
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 RED BUD RD NE
CALHOUN GA
30701-6010
US

IV. Provider business mailing address

5737 GARRETT DR
HIXSON TN
37343-3656
US

V. Phone/Fax

Practice location:
  • Phone: 706-602-7800
  • Fax:
Mailing address:
  • Phone: 678-848-1251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberGAA-CRNA004101
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: