Provider Demographics
NPI:1699856385
Name:WACHSMUTH, RHONDA ROUSE (MD)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:ROUSE
Last Name:WACHSMUTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 TOWNE LAKE PKWY STE 312
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-1604
Mailing Address - Country:US
Mailing Address - Phone:678-370-0370
Mailing Address - Fax:678-370-0371
Practice Address - Street 1:900 TOWNE LAKE PKWY STE 312
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-1604
Practice Address - Country:US
Practice Address - Phone:678-370-0370
Practice Address - Fax:678-370-0371
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA56664208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1750151OtherUNITED HEALTHCARE
GA87833OtherBLUE CROSS BLUE SHIELD
GAF63999Medicare UPIN
GA87833OtherBLUE CROSS BLUE SHIELD