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General NPI Number Information
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NPI Number | 1033425939
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Entity Type | Organization
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Legal Business Name | RAUSCH FAMILY PRACTICE
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Dates
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Enumeration Date | 08/30/2010
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Last Update Date | 08/30/2010
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Provider Practice Location Address
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Address Line | 1000 WYNGATE PKWY SUITE 210
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City | WOODSTOCK
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State | GA
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Zip | 30189-6981
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Country | US
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Telephone | 678-384-7305
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Fax | 770-928-9109
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Provider Business Mailing Address
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Address Line | 1000 WYNGATE PKWY SUITE 210
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City | WOODSTOCK
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State | GA
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Zip | 30189-6981
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Country | US
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Telephone | 678-384-7305
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Fax | 770-928-9109
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. JUDITH RAUSCH
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Credential | M.D.
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Telephone | 404-444-6416
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 019757
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License Number State | GA
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