Provider Demographics
NPI:1396020210
Name:RUAN SURGICAL SERVICES
Entity type:Organization
Organization Name:RUAN SURGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENYA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUAN
Authorized Official - Suffix:
Authorized Official - Credentials:CSA
Authorized Official - Phone:404-671-9556
Mailing Address - Street 1:PO BOX 1251
Mailing Address - Street 2:
Mailing Address - City:REDAN
Mailing Address - State:GA
Mailing Address - Zip Code:30074-1251
Mailing Address - Country:US
Mailing Address - Phone:404-671-9556
Mailing Address - Fax:
Practice Address - Street 1:950 CREEK COVE WAY
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-8606
Practice Address - Country:US
Practice Address - Phone:404-671-9556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty