Provider Demographics
NPI:1780071845
Name:RUIZ, GERALDINE
Entity type:Individual
Prefix:
First Name:GERALDINE
Middle Name:
Last Name:RUIZ
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 1:259 ARROWHEAD BLVD
Mailing Address - Street 2:C2
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-1167
Mailing Address - Country:US
Mailing Address - Phone:678-545-6053
Mailing Address - Fax:678-545-6119
Practice Address - Street 1:259 ARROWHEAD BLVD
Practice Address - Street 2:C2
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1167
Practice Address - Country:US
Practice Address - Phone:678-545-6053
Practice Address - Fax:678-545-6119
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health