MEDICARE: STRAIGHT SHOT MOBILE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	202K00000X	Phlebology Physician
2	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1851246300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STRAIGHT SHOT MOBILE LLC

Provider Business Mailing Address
First Line	:	2760 TROTTERS WALK TRL
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-4520
Country	:	US
Telephone Number	:	404-804-5482
Fax Number	:	888-365-1441

Provider Business Practice Location Address
First Line	:	2760 TROTTERS WALK TRL
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-4520
Country	:	US
Telephone Number	:	404-804-5482
Fax Number	:	888-365-1441

Authorized Official
Title or Position	:	DIRECTOR
Name	:	NICHOLE RUFFIN
Credential	:
Telephone Number	:	470-544-1082

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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Directions to “STRAIGHT SHOT MOBILE LLC ” Practice Location

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