Healthcare Provider Details

I. General information

NPI: 1780323832
Provider Name (Legal Business Name): RUSUDANI GOLETIANI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2022
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MANNING DRIVE
CHAPEL HILL NC
27514
US

IV. Provider business mailing address

170 MANNING, DRIVE, CB# 7025
CHAPEL HILL NC
27599-7025
US

V. Phone/Fax

Practice location:
  • Phone: 919-966-8162
  • Fax: 919-966-2922
Mailing address:
  • Phone: 919-966-8162
  • Fax: 919-966-2922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2026-02859
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: