Organization
MICHELE J. RUSIN, PH.D PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH WARNER (BILLING ADMINISTRATOR)
(770) 458-1594
Entity
Organization
Contact information
Practice address
1776 BRIARCLIFF RD NE, ATLANTA, GA 30306-2106
(404) 558-3639
Mailing address
PO BOX 133207, ATLANTA, GA 30333-3207
(404) 558-3639
(770) 458-1596
Taxonomy
Speciality
Code
Description
License number
State
103TR0400X
Rehabilitation Psychologist
Primary
1078
GA
Other
Enumeration date
11/02/2007
Last updated
11/02/2007
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