| Judith Ruth Medical Center Llc | |
|
1707 Blair Bridge Rd Austell GA 30168-5537 | |
| (404) 793-3806 | |
| (770) 502-6715 |
| Full Name | Judith Ruth Medical Center Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 1707 Blair Bridge Rd, Austell, Georgia |
| Authorized Official Name and Position | Natalie Mccall-gaston (CEO/FOUNDER) |
| Authorized Official Contact | 4047933806 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Judith Ruth Medical Center Llc 1707 Blair Bridge Rd Austell GA 30168-5537 Ph: (404) 793-3806 | Judith Ruth Medical Center Llc 1707 Blair Bridge Rd Austell GA 30168-5537 Ph: (404) 793-3806 |
| NPI Number | 1144912270 |
|---|---|
| Provider Enumeration Date | 05/25/2023 |
| Last Update Date | 05/25/2023 |
| Medicare PECOS PAC ID | 8628437902 |
|---|---|
| Medicare Enrollment ID | O20230705001149 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144912270 | NPI | - | NPPES |
| 003137957D | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Primary |
| Provider Name | Debbie R Brewer |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1215209275 PECOS PAC ID: 3678541133 Enrollment ID: I20040922000526 |
| Provider Name | Natalie Y Mccall-gaston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639515455 PECOS PAC ID: 4587806542 Enrollment ID: I20130805000419 |
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