Provider Demographics
NPI:1821090705
Name:RUCKET, ALAN N (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:N
Last Name:RUCKET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 IVY FALLS DR
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-3658
Mailing Address - Country:US
Mailing Address - Phone:404-255-1005
Mailing Address - Fax:404-255-1184
Practice Address - Street 1:1005 IVY FALLS DR
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-3658
Practice Address - Country:US
Practice Address - Phone:404-255-1005
Practice Address - Fax:404-255-1184
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA15980174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00442065AMedicaid
GAD30665Medicare UPIN
GA16BDFUNMedicare ID - Type Unspecified