Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 071628 | GA |
NPI | 1023242195 |
---|---|
Provider Name | Dr. Jonathan W. Rutledge |
First Address | Evans, GA 30809-3000 |
Second Address | Evans, GA 30809-3000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2009 |
Last Update Date | 18/02/2016 |