Provider Demographics
NPI:1710483938
Name:WEI, RUTH W
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:W
Last Name:WEI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 HICKORY FLAT HWY
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-3413
Mailing Address - Country:US
Mailing Address - Phone:404-256-1727
Mailing Address - Fax:404-252-3591
Practice Address - Street 1:1521 HICKORY FLAT HWY
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-3413
Practice Address - Country:US
Practice Address - Phone:404-256-1727
Practice Address - Fax:404-252-3591
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA87943207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program