Provider Demographics
NPI:1992803720
Name:RUDDOCK-SOLOMON, NOELLE E (MD)
Entity type:Individual
Prefix:
First Name:NOELLE
Middle Name:E
Last Name:RUDDOCK-SOLOMON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4855 RIVER GREEN PKWY
Mailing Address - Street 2:SUITE 610
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-8336
Mailing Address - Country:US
Mailing Address - Phone:770-232-1444
Mailing Address - Fax:
Practice Address - Street 1:4855 RIVER GREEN PKWY
Practice Address - Street 2:SUITE 610
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8336
Practice Address - Country:US
Practice Address - Phone:770-232-1444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041355208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics