Individual
COUNCILL C RUDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
822 MCARTHUR ST, MANCHESTER, TN 37355-2324
(931) 723-7121
(931) 723-7133
Mailing address
15 VETERANS DR, DECHERD, TN 37324-3887
(931) 962-2273
(931) 962-2202
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD0000025899
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3091133
—
TN
Enumeration date
06/18/2006
Last updated
04/14/2016
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