Organization
BENJAMIN L. RUCKER M.D. P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BEVERLY MICHELE JACKSON (MEDICAL ASSISTANT/ OFFICE MANAGER)
(706) 733-9447
Entity
Organization
Contact information
Practice address
1138 DRUID PARK AVE, SUITE B, AUGUSTA, GA 30904-5850
(706) 733-9447
(706) 738-0863
Mailing address
1138 DRUID PARK AVE, SUITE B, AUGUSTA, GA 30904-5850
(706) 733-9447
(706) 738-0863
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
017877
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000153139-B
—
GA
01
—
010270
BCBS
—
05
—
G17877
—
SC
Enumeration date
05/29/2008
Last updated
05/29/2008
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