Provider Demographics
NPI:1649864653
Name:RUTLAND-BURRUS, JOSETTE
Entity type:Individual
Prefix:
First Name:JOSETTE
Middle Name:
Last Name:RUTLAND-BURRUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3464 BOULDER LN
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-3702
Mailing Address - Country:US
Mailing Address - Phone:678-392-6224
Mailing Address - Fax:
Practice Address - Street 1:13031 VETERANS MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-1639
Practice Address - Country:US
Practice Address - Phone:678-392-6224
Practice Address - Fax:888-510-3816
Is Sole Proprietor?:No
Enumeration Date:2021-02-22
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator