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General NPI Number Information
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NPI Number | 1972460194
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Entity Type | Organization
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Legal Business Name | ST. RUTH BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 01/08/2026
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Last Update Date | 01/08/2026
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Provider Practice Location Address
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Address Line | 1841 MONTREAL RD STE 110E
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City | TUCKER
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State | GA
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Zip | 30084-5713
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Country | US
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Telephone | 678-789-7299
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Fax |
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Provider Business Mailing Address
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Address Line | 939 ASHTON PARK CT
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-7055
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NADEGE PONE
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Credential |
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Telephone | 678-789-7299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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