Individual
DAVID SAMUEL RUDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
354 NEWNAN CROSSING BYP, SUITE 205, NEWNAN, GA 30265-2323
(678) 326-4812
Mailing address
95 COLLIER RD NW, SUITE 4075, ATLANTA, GA 30309-1796
(404) 355-3200
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
OS014560
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
037276
MLHC GROUP AA #
PA
01
—
1922077643
MLHC GROUP NPI #
PA
01
—
440771
MLHC MEDICARE AA#
PA
01
—
824305
BS AA#
PA
01
—
OS14560
PA MEDICAL LICENSE #
—
Enumeration date
04/02/2009
Last updated
10/13/2014
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