Basic Information
| Provider Information | |||||||||
| NPI: | 1063466506 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUSU | ||||||||
| FirstName: | DANIELA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3475 LENOX RD NE | ||||||||
| Address2: | SUITE 655 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303263227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4044788785 | ||||||||
| FaxNumber: | 8667823143 | ||||||||
| Practice Location | |||||||||
| Address1: | 1133 EAGLES LANDING PKWY | ||||||||
| Address2: | |||||||||
| City: | STOCKBRIDGE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302815085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6786041053 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 03/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 35472 | IA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 063124 | GA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | P00158897 | 01 | IA | RAILROAD MEDICARE | OTHER | 37038 | 01 | IA | BLUE CROSS BLUE SHIELD | OTHER | 245516 | 01 | IA | MIDLANDS CHOICE | OTHER | 0441337 | 05 | IA | MEDICAID |