Provider Demographics
NPI:1245795756
Name:WALKER-HARRIS, RUTH (LAT,ATC, EMT-B)
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:
Last Name:WALKER-HARRIS
Suffix:
Gender:F
Credentials:LAT,ATC, EMT-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 BURKLAND DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30601-4090
Mailing Address - Country:US
Mailing Address - Phone:570-972-7802
Mailing Address - Fax:
Practice Address - Street 1:1270 HIGHWAY 29 N
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-1128
Practice Address - Country:US
Practice Address - Phone:570-972-7802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-08
Last Update Date:2020-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA146N00000X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty