Healthcare Provider Details

I. General information

NPI: 1942397203
Provider Name (Legal Business Name): EDWARD WOOD RUFFIN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 EMERY HIGHWAY
MACON GA
31217
US

IV. Provider business mailing address

175 EMERY HIGHWAY
MACON GA
31217
US

V. Phone/Fax

Practice location:
  • Phone: 478-803-7631
  • Fax: 478-751-4530
Mailing address:
  • Phone: 478-803-7631
  • Fax: 478-751-4430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number001481
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: