Healthcare Provider Details

I. General information

NPI: 1033251343
Provider Name (Legal Business Name): MRS. RUTHIE LEE CULVER-REED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

977A TAYLOR ST SW
CONYERS GA
30012-5357
US

IV. Provider business mailing address

4428 OLD OAK DR
CONYERS GA
30094-8004
US

V. Phone/Fax

Practice location:
  • Phone: 770-918-6677
  • Fax:
Mailing address:
  • Phone: 770-679-1365
  • Fax: 770-679-1368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: