Provider Demographics
NPI:1164809885
Name:GOYES RUIZ, VANESSA N (MD)
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:N
Last Name:GOYES RUIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 FRANKLIN STREET
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06706
Mailing Address - Country:US
Mailing Address - Phone:203-709-8685
Mailing Address - Fax:
Practice Address - Street 1:2301 NEWNAN CROSSING BLVD E STE 210
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2576
Practice Address - Country:US
Practice Address - Phone:770-400-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2023-12-01
Deactivation Date:2015-12-09
Deactivation Code:
Reactivation Date:2016-01-19
Provider Licenses
StateLicense IDTaxonomies
GA96795207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine