Provider Demographics
NPI:1386997039
Name:RUIZ, ADRIANA SOFIA (PA-C)
Entity type:Individual
Prefix:MISS
First Name:ADRIANA
Middle Name:SOFIA
Last Name:RUIZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ADRIANA
Other - Middle Name:SOFIA
Other - Last Name:RUIZ ROSARIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:1800 HOWELL MILL RD NW STE 450
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2508
Mailing Address - Country:US
Mailing Address - Phone:404-355-4393
Mailing Address - Fax:404-609-7665
Practice Address - Street 1:1800 HOWELL MILL RD NW STE 450
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-2508
Practice Address - Country:US
Practice Address - Phone:404-355-4393
Practice Address - Fax:404-609-7665
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1383363AM0700X
GA11364363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003281920AMedicaid