Provider Demographics
NPI:1225151764
Name:RUDISCH, BRUCE EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:EDWARD
Last Name:RUDISCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:27 LENOX POINTE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-3172
Mailing Address - Country:US
Mailing Address - Phone:404-237-3210
Mailing Address - Fax:404-237-6986
Practice Address - Street 1:27 LENOX POINTE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-3172
Practice Address - Country:US
Practice Address - Phone:404-237-3210
Practice Address - Fax:404-237-6986
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0515422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry