Healthcare Provider Details

I. General information

NPI: 1255854311
Provider Name (Legal Business Name): NANCY JANE GELLER RUDY D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5949 BUFORD HWY
NORCROSS GA
30071-2472
US

IV. Provider business mailing address

120 SPALDING CREEK CT
SANDY SPRINGS GA
30350-1176
US

V. Phone/Fax

Practice location:
  • Phone: 678-280-6630
  • Fax:
Mailing address:
  • Phone: 404-771-7709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDNV000014
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: