Provider Demographics
NPI:1962634212
Name:RUST, CYNTHIA T (MD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:T
Last Name:RUST
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 1:165 MOUNT VERNON DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1606
Mailing Address - Country:US
Mailing Address - Phone:404-373-9580
Mailing Address - Fax:
Practice Address - Street 1:165 MOUNT VERNON DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1606
Practice Address - Country:US
Practice Address - Phone:404-373-9580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035132208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics