Provider Demographics
NPI:1215266135
Name:PRATER, RUBIN BURT (MD)
Entity type:Individual
Prefix:DR
First Name:RUBIN
Middle Name:BURT
Last Name:PRATER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11187 BIG CANOE
Mailing Address - Street 2:
Mailing Address - City:BIG CANOE
Mailing Address - State:GA
Mailing Address - Zip Code:30143-5102
Mailing Address - Country:US
Mailing Address - Phone:770-367-1700
Mailing Address - Fax:
Practice Address - Street 1:HIGHWAY 58 - GALLAHER ROAD
Practice Address - Street 2:K-1007, MS-7422
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37831-4699
Practice Address - Country:US
Practice Address - Phone:865-574-8562
Practice Address - Fax:865-241-4636
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-24
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35891174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist