Provider Demographics
NPI:1497142566
Name:FUQUA, RUTH (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:FUQUA
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 W FRANKLIN ST
Mailing Address - Street 2:APT 613
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-2536
Mailing Address - Country:US
Mailing Address - Phone:404-788-4736
Mailing Address - Fax:
Practice Address - Street 1:140 W FRANKLIN ST
Practice Address - Street 2:APT 613
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-2536
Practice Address - Country:US
Practice Address - Phone:404-788-4736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-25132081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine