Provider Demographics
NPI:1760818124
Name:RUTLAND, KATIE ELIZABETH (MA)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:ELIZABETH
Last Name:RUTLAND
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:KATIE
Other - Middle Name:ELIZABETH
Other - Last Name:BLOODWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4350 BARRINGTON PL
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-4934
Mailing Address - Country:US
Mailing Address - Phone:912-322-7539
Mailing Address - Fax:
Practice Address - Street 1:761 POPLAR ST
Practice Address - Street 2:STE 1-K
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2082
Practice Address - Country:US
Practice Address - Phone:478-412-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist