Provider Demographics
NPI:1629638440
Name:RUTLEDGE, TAMARA ALLISON (CNP)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:ALLISON
Last Name:RUTLEDGE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:A
Other - Last Name:DIMAIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1800 NORTHSIDE FORSYTH DR STE 350
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-8483
Mailing Address - Country:US
Mailing Address - Phone:770-886-3555
Mailing Address - Fax:678-807-6050
Practice Address - Street 1:1800 NORTHSIDE FORSYTH DR STE 350
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-8483
Practice Address - Country:US
Practice Address - Phone:770-886-3555
Practice Address - Fax:678-807-6050
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN319814363LF0000X
FLAPRN11003092363LF0000X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily