Healthcare Provider Details

I. General information

NPI: 1396020210
Provider Name (Legal Business Name): RUAN SURGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2011
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 CREEK COVE WAY
LOGANVILLE GA
30052-8606
US

IV. Provider business mailing address

PO BOX 1251
REDAN GA
30074-1251
US

V. Phone/Fax

Practice location:
  • Phone: 404-671-9556
  • Fax:
Mailing address:
  • Phone: 404-671-9556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: KENYA RUAN
Title or Position: OWNER, PRESIDENT
Credential: CSA
Phone: 404-671-9556