Healthcare Provider Details

I. General information

NPI: 1386880979
Provider Name (Legal Business Name): DONNA L RUIZ RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2009
Last Update Date: 01/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 CLAIRMONT ROAD RM 6C117 ATLANTA VA MEDICAL CENTER
ATLANTA GA
30033
US

IV. Provider business mailing address

111 1/2 DEER PARK LANE
CALHOUN GA
30701
US

V. Phone/Fax

Practice location:
  • Phone: 404-321-6111
  • Fax:
Mailing address:
  • Phone: 678-767-9401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD002115
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: