=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851246300
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STRAIGHT SHOT MOBILE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2026
-----------------------------------------------------
Last Update Date | 03/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2760 TROTTERS WALK TRL
-----------------------------------------------------
City | SNELLVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30078-4520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-804-5482
-----------------------------------------------------
Fax | 888-365-1441
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2760 TROTTERS WALK TRL
-----------------------------------------------------
City | SNELLVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30078-4520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-804-5482
-----------------------------------------------------
Fax | 888-365-1441
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | NICHOLE RUFFIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 470-544-1082
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 202K00000X
-----------------------------------------------------
Taxonomy Name | Phlebology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------