Provider Demographics
NPI:1225116155
Name:RUDERT, CYNTHIA S (MD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:S
Last Name:RUDERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 PEACHTREE DUNWOODY RD
Mailing Address - Street 2:STE 312
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:404-943-9820
Mailing Address - Fax:404-943-9827
Practice Address - Street 1:5555 PEACHTREE DUNWOODY RD
Practice Address - Street 2:STE 312
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-943-9820
Practice Address - Fax:404-943-9827
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA23103207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10BBBMNMedicare ID - Type Unspecified
D30671Medicare UPIN