Provider Demographics
NPI:1558197871
Name:RUMINSKI, KELLY (PHD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:
Last Name:RUMINSKI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 W PONCE DE LEON AVE UNIT 183
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2427
Mailing Address - Country:US
Mailing Address - Phone:716-517-6779
Mailing Address - Fax:
Practice Address - Street 1:199 ARMOUR DR NE STE E
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-3975
Practice Address - Country:US
Practice Address - Phone:716-517-6779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth