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General NPI Number Information
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NPI Number | 1972581452
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Entity Type | Individual
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Provider Name | JOSEPH E CARRUTH MD
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Gender | Male
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Dates
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Enumeration Date | 01/05/2006
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Last Update Date | 09/18/2015
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Provider Practice Location Address
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Address Line | 104 FAIRVIEW PARK DR
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City | DUBLIN
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State | GA
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Zip | 31021
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Country | US
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Telephone | 478-272-1366
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Fax | 478-277-1922
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Provider Business Mailing Address
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Address Line | PO BOX 407
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City | VIDALIA
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State | GA
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Zip | 30475-0407
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Country | US
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Telephone | 478-275-3166
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Fax | 478-277-1922
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 019653
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License Number State | GA
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