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General NPI Number Information
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NPI Number | 1922872019
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Entity Type | Organization
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Legal Business Name | RUSHA GEORGE AWAD, LLC
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Dates
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Enumeration Date | 11/09/2023
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Last Update Date | 11/09/2023
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Provider Practice Location Address
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Address Line | 450100 STATE ROAD 200
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City | CALLAHAN
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State | FL
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Zip | 32011-5064
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Country | US
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Telephone | 904-879-6998
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Fax |
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Provider Business Mailing Address
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Address Line | 4570 BRANDY OAK CT
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City | JACKSONVILLE
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State | FL
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Zip | 32257-8818
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Country | US
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Telephone | 904-204-4766
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RUSHA AWAD
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Credential | DMD
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Telephone | 904-207-4766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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