Provider Demographics
NPI:1407260557
Name:RUTLEDGE MEDICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:RUTLEDGE MEDICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEKEIDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUTLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-213-0241
Mailing Address - Street 1:2788 BAYARD ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-3441
Mailing Address - Country:US
Mailing Address - Phone:813-728-3414
Mailing Address - Fax:
Practice Address - Street 1:2788 BAYARD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-3441
Practice Address - Country:US
Practice Address - Phone:813-728-3414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-17
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care