Healthcare Provider Details

I. General information

NPI: 1447798822
Provider Name (Legal Business Name): CRISTAL RUSH MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 DIXIE ST
CARROLLTON GA
30117-4408
US

IV. Provider business mailing address

905 DIXIE ST
CARROLLTON GA
30117-4408
US

V. Phone/Fax

Practice location:
  • Phone: 770-812-5003
  • Fax: 770-812-5832
Mailing address:
  • Phone: 770-812-5003
  • Fax: 770-812-5832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP201541
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: