Provider Demographics
NPI:1992465710
Name:RUTHERFORD, CHARLES ANTHONY (RN)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:ANTHONY
Last Name:RUTHERFORD
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:RUTHERFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:581 BLUE RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30560-2683
Mailing Address - Country:US
Mailing Address - Phone:706-400-0981
Mailing Address - Fax:706-374-4209
Practice Address - Street 1:720 WOOD ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-4413
Practice Address - Country:US
Practice Address - Phone:707-268-2990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95219778163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health