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General NPI Number Information
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NPI Number | 1811981756
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Entity Type | Individual
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Provider Name | JORDAN S RUSH MD
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Gender | Male
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Dates
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Enumeration Date | 09/07/2005
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Last Update Date | 01/30/2024
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Provider Practice Location Address
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Address Line | 10515 BELLS FERRY RD SUITE 200
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City | CANTON
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State | GA
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Zip | 30114-4204
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Country | US
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Telephone | 770-720-8551
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Fax | 770-345-2738
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Provider Business Mailing Address
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Address Line | 3611 SHAMANS WALK
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City | MARIETTA
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State | GA
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Zip | 30062-1063
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Country | US
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Telephone | 404-434-7785
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 60319
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD049482L
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License Number State | PA
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