Provider Demographics
NPI:1902931058
Name:BUTLER RICE, ANGELA RUTH (MD)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:RUTH
Last Name:BUTLER RICE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 LAWRENCEVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-3200
Mailing Address - Country:US
Mailing Address - Phone:770-696-2968
Mailing Address - Fax:678-691-3460
Practice Address - Street 1:2403 LAWRENCEVILLE HWY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-3200
Practice Address - Country:US
Practice Address - Phone:770-696-2968
Practice Address - Fax:678-691-3460
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200101531208000000X
GA053678208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003127345AMedicaid
GA003127345AMedicaid