Provider Demographics
NPI:1376510982
Name:RUFFIN, JOHNNA W (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHNNA
Middle Name:W
Last Name:RUFFIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3726
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30914-3726
Mailing Address - Country:US
Mailing Address - Phone:706-863-9595
Mailing Address - Fax:888-745-3917
Practice Address - Street 1:3675 J DEWEY GRAY CIRCLE
Practice Address - Street 2:SUITE 300
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-1868
Practice Address - Country:US
Practice Address - Phone:706-863-9595
Practice Address - Fax:888-745-3917
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPA2352363AS0400X
FLPA9113053363AS0400X
GA3452363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP92697Medicare UPIN
GA97WCFJNMedicare ID - Type Unspecified
SC0235PAMedicaid
GA100002359AMedicaid