Individual
DR. STEPHEN A RUBENDALL JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
259 US HIGHWAY 19 NORTH, CAMILLA, GA 31730-1410
(229) 336-1949
(229) 336-1436
Mailing address
259 US HIGHWAY 19 NORTH, CAMILLA, GA 31730-1410
(229) 336-1949
(229) 336-1436
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
057320
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25806
STATE LICENSE
SC
05
—
467902058A
—
GA
Enumeration date
05/20/2006
Last updated
04/10/2019
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