Basic Information
| Provider Information | |||||||||
| NPI: | 1710035001 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUFFIN | ||||||||
| FirstName: | SALIEM | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 119 AMBULANCE DR | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | CARROLLTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301173857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708388929 | ||||||||
| FaxNumber: | 7708388930 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 JOHNSON FERRY RD | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048518000 | ||||||||
| FaxNumber: | 4043033759 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 058769 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 058769 | GA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 367772176B | 01 | GA | MEDICAID ADDL LOCATION | OTHER | GRP6268 | 01 | GA | MEDICARE GROUP | OTHER | 367772176A | 05 | GA | MEDICAID | 367772176C | 01 | GA | MEDICAID ADDL LOCATION | OTHER |