Provider Demographics
NPI:1245556273
Name:ARUKAH MEDICINE
Entity type:Organization
Organization Name:ARUKAH MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:D
Authorized Official - Last Name:BLEDSOE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:706-403-4613
Mailing Address - Street 1:407 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-2101
Mailing Address - Country:US
Mailing Address - Phone:706-403-4613
Mailing Address - Fax:866-348-6516
Practice Address - Street 1:407 2ND AVE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-2101
Practice Address - Country:US
Practice Address - Phone:706-403-4613
Practice Address - Fax:866-348-6516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-15
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041730207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11BDNFSMedicaid
GA000725612CMedicaid
GA11BDNFSMedicaid