Individual
SHOMARI ANDRE RUFFIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
150 CLINIC AVE, SUITE 101, CARROLLTON, GA 30117-4401
(770) 834-0873
(770) 834-6118
Mailing address
150 CLINIC AVE, SUITE 101, CARROLLTON, GA 30117-4401
(770) 834-0873
(770) 834-6118
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
72107
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
REF000630555
—
GA
Enumeration date
05/29/2008
Last updated
10/30/2014
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