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NPI Code Detail

MEDICARE: MICHELE J. RUSIN, PH.D PC

MEDICARE: MICHELE J. RUSIN, PH.D PC
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
1103TR0400XRehabilitation Psychologist1078GA

General Provider Information

NPI Number : 1396924692
Entity Type Code : Organization
Provider Name (Legal Business Name) : MICHELE J. RUSIN, PH.D PC
Provider Business Mailing Address
First Line : PO BOX 133207
Second Line :
City : ATLANTA
State : GA
Zip : 30333-3207
Country : US
Telephone Number : 404-558-3639
Fax Number : 770-458-1596
Provider Business Practice Location Address
First Line : 1776 BRIARCLIFF RD NE
Second Line :
City : ATLANTA
State : GA
Zip : 30306-2106
Country : US
Telephone Number : 404-558-3639
Fax Number :
Authorized Official
Title or Position : BILLING ADMINISTRATOR
Name : MR. KENNETH WARNER
Credential :
Telephone Number : 770-458-1594
Provider Enumeration Date : 11/02/2007
Last Update Date : 11/02/2007

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