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General NPI Number Information
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NPI Number | 1326759408
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Entity Type | Organization
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Legal Business Name | RUTHERFORD MEDICAL CENTER LLC
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Dates
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Enumeration Date | 12/08/2022
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Last Update Date | 12/08/2022
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Provider Practice Location Address
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Address Line | 12755 CENTURY DR UNIT A
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City | ALPHARETTA
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State | GA
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Zip | 30009-8377
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Country | US
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Telephone | 770-696-2265
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Fax | 770-696-2156
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Provider Business Mailing Address
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Address Line | 12755 CENTURY DR UNIT A
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City | ALPHARETTA
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State | GA
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Zip | 30009-8377
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Country | US
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Telephone | 770-696-2265
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Fax | 770-696-2156
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Authorized Official
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Title or Position | MANAGER
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Name | DR. KEVIENE RUTHERFORD
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Credential | MD
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Telephone | 954-483-1436
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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