| Rutherford Medical Center Llc | |
|
12755 Century Dr Unit A Alpharetta GA 30009-8377 | |
| (770) 696-2265 | |
| (770) 696-2156 |
| Full Name | Rutherford Medical Center Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 12755 Century Dr Unit A, Alpharetta, Georgia |
| Authorized Official Name and Position | Keviene Rutherford (MANAGER) |
| Authorized Official Contact | 9544831436 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rutherford Medical Center Llc 12755 Century Dr Unit A Alpharetta GA 30009-8377 Ph: (770) 696-2265 | Rutherford Medical Center Llc 12755 Century Dr Unit A Alpharetta GA 30009-8377 Ph: (770) 696-2265 |
| NPI Number | 1326759408 |
|---|---|
| Provider Enumeration Date | 12/08/2022 |
| Last Update Date | 12/08/2022 |
| Medicare PECOS PAC ID | 1456721950 |
|---|---|
| Medicare Enrollment ID | O20221227001660 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326759408 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Keviene Wayne Rutherford |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902811664 PECOS PAC ID: 6507848363 Enrollment ID: I20221227001031 |
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