Shomari Andre Ruffin
Sports Medicine Orthopaedic Surgeon
150 Clinic Ave Suite 101
Carrollton
, Georgia 30117-4401
Shomari Andre Ruffin
Sports Medicine Orthopaedic Surgeon
150 Clinic Ave Suite 101
Carrollton
, Georgia 30117-4401
(770) 834-6118
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About
Features
Specialties
- Sports Medicine Orthopaedic Surgeon
Languages spoken
- English
Location
First Address
- Shomari Andre Ruffin
- 150 Clinic Ave Suite 101
- Carrollton, GA
- Zip : 30117-4401
- Fax : (770) 834-6118
- Phone : (770) 834-0873
Second Address
- Shomari Andre Ruffin
- 150 Clinic Ave Suite 101
- Carrollton, GA
- Zip : 30117-4401
- Fax : (770) 834-6118
- Phone : (770) 834-0873
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 72107 | GA |
National Provider Identifier
| NPI | 1114185840 |
|---|---|
| Provider Name | Shomari Andre Ruffin |
| First Address | Carrollton, GA 30117-4401 |
| Second Address | Carrollton, GA 30117-4401 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 29/05/2008 |
| Last Update Date | 30/10/2014 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| REF000630555 | (05) | GA |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.