Provider Demographics
NPI:1043071814
Name:RUFFIN, THOMAS LAMONT JR
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:LAMONT
Last Name:RUFFIN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12428 MAYS QUARTER RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-5461
Mailing Address - Country:US
Mailing Address - Phone:571-552-2756
Mailing Address - Fax:
Practice Address - Street 1:4505 LAKELAND CT
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-9215
Practice Address - Country:US
Practice Address - Phone:706-204-9112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other