Healthcare Provider Details

I. General information

NPI: 1598691388
Provider Name (Legal Business Name): MR. KERRY LIONEL RUFFIN SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 JONESBORO RD # 1019
JONESBORO GA
30236-2468
US

IV. Provider business mailing address

127 JONESBORO RD # 1019
JONESBORO GA
30236-2468
US

V. Phone/Fax

Practice location:
  • Phone: 713-258-3232
  • Fax:
Mailing address:
  • Phone: 713-258-3232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: