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General NPI Number Information
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NPI Number | 1841089042
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Entity Type | Individual
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Provider Name | DAVID CARRUTH CPS-AD
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Gender | Male
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Dates
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Enumeration Date | 05/05/2025
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 8335 OFFICE PARK DR
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-6937
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Country | US
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Telephone | 678-324-0476
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Fax |
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Provider Business Mailing Address
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Address Line | 450 DAN PL SE
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City | SMYRNA
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State | GA
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Zip | 30082-2527
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Country | US
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Telephone |
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State | GA
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