Provider Demographics
NPI:1114935822
Name:RUTLEDGE, WILLIAM SAMUEL (PA)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:SAMUEL
Last Name:RUTLEDGE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 DARTMORE CT
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-5227
Mailing Address - Country:US
Mailing Address - Phone:706-868-6282
Mailing Address - Fax:
Practice Address - Street 1:1175 DARTMORE CT
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-5227
Practice Address - Country:US
Practice Address - Phone:706-868-6282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002212363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical