Provider Demographics
NPI:1467630558
Name:RUMPH, BRADY R (MD)
Entity Type:Individual
Prefix:MRS
First Name:BRADY
Middle Name:R
Last Name:RUMPH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:BRADY
Other - Middle Name:ELIZABETH
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 7217
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-7217
Mailing Address - Country:US
Mailing Address - Phone:706-320-2773
Mailing Address - Fax:706-596-4226
Practice Address - Street 1:2300 MANCHESTER EXPY
Practice Address - Street 2:STE A6
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6802
Practice Address - Country:US
Practice Address - Phone:706-322-6646
Practice Address - Fax:706-322-3226
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001498207L00000X
GA063216207L00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I053426OtherMEDICARE PTAN
GA365137301Medicaid
AL123037Medicaid