Healthcare Provider Details

I. General information

NPI: 1841390309
Provider Name (Legal Business Name): JEFFREY LYNN RAUSCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4233 PLEASANT HILL RD STE 110
DULUTH GA
30096-1609
US

IV. Provider business mailing address

4233 PLEASANT HILL RD STE 110
DULUTH GA
30096-1609
US

V. Phone/Fax

Practice location:
  • Phone: 770-559-0550
  • Fax:
Mailing address:
  • Phone: 770-559-0550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number35121
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35121
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: