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General NPI Number Information
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NPI Number | 1578635389
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Entity Type | Individual
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Provider Name | KERITH STERN RUDNICKI MD
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Gender | Female
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1875 CENTURY BLVD, N.E. SUITE 150
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City | ATLANTA
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State | GA
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Zip | 30345
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Country | US
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Telephone | 404-633-4595
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Fax |
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Provider Business Mailing Address
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Address Line | 1875 CENTURY BLVD, N.E. SUITE 150
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City | ATLANTA
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State | GA
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Zip | 30345
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Country | US
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Telephone | 404-633-4595
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME0069453
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 58919
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License Number State | GA
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