Provider Demographics
NPI:1033425939
Name:RAUSCH FAMILY PRACTICE
Entity Type:Organization
Organization Name:RAUSCH FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:RAUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-444-6416
Mailing Address - Street 1:1000 WYNGATE PKWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-6981
Mailing Address - Country:US
Mailing Address - Phone:678-384-7305
Mailing Address - Fax:770-928-9109
Practice Address - Street 1:1000 WYNGATE PKWY
Practice Address - Street 2:SUITE 210
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-6981
Practice Address - Country:US
Practice Address - Phone:678-384-7305
Practice Address - Fax:770-928-9109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA019757207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD30566Medicare UPIN