Healthcare Provider Details

I. General information

NPI: 1508979964
Provider Name (Legal Business Name): ARTURO NATADA RUANTO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ARTURO NATADA RUANTO M.D.

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 09/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 SOUTH CHERRY ST.
OCILLA GA
31774
US

IV. Provider business mailing address

202 SOUTH CHERRY ST.
OCILLA GA
31774
US

V. Phone/Fax

Practice location:
  • Phone: 229-468-5015
  • Fax: 229-468-5018
Mailing address:
  • Phone: 229-468-5015
  • Fax: 229-468-5018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13102
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number052819
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: