Provider Demographics
NPI:1063856474
Name:RUCKER, MARGGI (EDS)
Entity Type:Individual
Prefix:
First Name:MARGGI
Middle Name:
Last Name:RUCKER
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3231 OLD FURNACE RD
Mailing Address - Street 2:
Mailing Address - City:CHESNEE
Mailing Address - State:SC
Mailing Address - Zip Code:29323-9639
Mailing Address - Country:US
Mailing Address - Phone:864-578-0128
Mailing Address - Fax:864-515-5198
Practice Address - Street 1:3231 OLD FURNACE RD
Practice Address - Street 2:
Practice Address - City:CHESNEE
Practice Address - State:SC
Practice Address - Zip Code:29323-9639
Practice Address - Country:US
Practice Address - Phone:864-578-0128
Practice Address - Fax:864-515-5198
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4613174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist