MEDICARE: GERALDINE RUIZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1780071845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALDINE RUIZ

Provider Business Mailing Address
First Line	:	259 ARROWHEAD BLVD
Second Line	:	C2
City	:	JONESBORO
State	:	GA
Zip	:	30236-1167
Country	:	US
Telephone Number	:	678-545-6053
Fax Number	:	678-545-6119

Provider Business Practice Location Address
First Line	:	259 ARROWHEAD BLVD
Second Line	:	C2
City	:	JONESBORO
State	:	GA
Zip	:	30236-1167
Country	:	US
Telephone Number	:	678-545-6053
Fax Number	:	678-545-6119

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2015
Last Update Date	:	04/16/2015

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Directions to “ GERALDINE RUIZ ” Practice Location

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