Provider Demographics
NPI:1578767596
Name:RUSHER, ROBERT RANDALL (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:RANDALL
Last Name:RUSHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3495 PIEDMONT ROAD, NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305
Mailing Address - Country:US
Mailing Address - Phone:404-364-7070
Mailing Address - Fax:803-540-1011
Practice Address - Street 1:3650 STEVE REYNOLDS BLVD.
Practice Address - Street 2:KAISER PERMANENTE GWINNETT MEDICAL CENTER
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096
Practice Address - Country:US
Practice Address - Phone:803-799-5022
Practice Address - Fax:803-799-5890
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC34083207R00000X, 207RC0200X, 207RP1001X
MD22267207RC0200X, 207RP1001X
GA066315207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC340839Medicaid
SCAA76842603OtherMEDICARE PTAN