Provider Demographics
NPI:1841216447
Name:RAUSCH, JUDITH T (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:T
Last Name:RAUSCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1000 WYNGATE PKWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-6981
Mailing Address - Country:US
Mailing Address - Phone:678-384-7305
Mailing Address - Fax:770-928-9109
Practice Address - Street 1:1000 WYNGATE PKWY
Practice Address - Street 2:SUITE 210
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-6981
Practice Address - Country:US
Practice Address - Phone:678-384-7305
Practice Address - Fax:770-928-9109
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2013-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA019757207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA088DPFFMedicare ID - Type Unspecified
GAD30566Medicare UPIN