MEDICARE: JUDITH RUTH MEDICAL CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center
2	363LF0000X	Family Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144912270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUDITH RUTH MEDICAL CENTER LLC

Provider Business Mailing Address
First Line	:	10494 VETERANS MEMORIAL HWY STE 5
Second Line	:
City	:	LITHIA SPRINGS
State	:	GA
Zip	:	30122-2061
Country	:	US
Telephone Number	:	404-793-3806
Fax Number	:	770-502-6715

Provider Business Practice Location Address
First Line	:	10494 VETERANS MEMORIAL HWY STE 5
Second Line	:
City	:	LITHIA SPRINGS
State	:	GA
Zip	:	30122-2061
Country	:	US
Telephone Number	:	404-793-3806
Fax Number	:	770-502-6715

Authorized Official
Title or Position	:	CEO/FOUNDER
Name	:	MRS. NATALIE MCCALL-GASTON
Credential	:	FNP
Telephone Number	:	404-793-3806

Provider Enumeration Date	:	05/25/2023
Last Update Date	:	03/25/2025

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