Rutherford Medical Center Llc | |
12755 Century Dr Unit A Alpharetta GA 30009-8377 | |
(770) 696-2265 | |
(770) 696-2156 |
Full Name | Rutherford Medical Center Llc |
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Speciality | Internal Medicine |
Location | 12755 Century Dr Unit A, Alpharetta, Georgia |
Authorized Official Name and Position | Keviene Rutherford (MANAGER) |
Authorized Official Contact | 9544831436 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Rutherford Medical Center Llc 12755 Century Dr Unit A Alpharetta GA 30009-8377 Ph: (770) 696-2265 | Rutherford Medical Center Llc 12755 Century Dr Unit A Alpharetta GA 30009-8377 Ph: (770) 696-2265 |
NPI Number | 1326759408 |
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Provider Enumeration Date | 12/08/2022 |
Last Update Date | 12/08/2022 |
Medicare PECOS PAC ID | 1456721950 |
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Medicare Enrollment ID | O20221227001660 |
Identifier | Type | State | Issuer |
---|---|---|---|
1326759408 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207R00000X | Internal Medicine | (* (Not Available)) | Primary |
Provider Name | Keviene Wayne Rutherford |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1902811664 PECOS PAC ID: 6507848363 Enrollment ID: I20221227001031 |
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