Healthcare Provider Details

I. General information

NPI: 1063466506
Provider Name (Legal Business Name): DANIELA RUSU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 EAGLES LANDING PKWY
STOCKBRIDGE GA
30281-5085
US

IV. Provider business mailing address

3475 LENOX RD NE SUITE 655
ATLANTA GA
30326-3227
US

V. Phone/Fax

Practice location:
  • Phone: 678-604-1053
  • Fax:
Mailing address:
  • Phone: 404-478-8785
  • Fax: 866-782-3143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35472
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number063124
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: