Individual
MR. BENJAMIN LAVAR RUCKER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1448 LEE BEARD WAY, AUGUSTA, GA 30901-3414
(706) 828-7468
(706) 724-7566
Mailing address
1448 LEE BEARD WAY, AUGUSTA, GA 30901-3414
(706) 828-7468
(706) 724-7566
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
—
01
—
0400527
UNITED HEALTHCARE
—
01
—
581476757
COMMERCIAL
—
01
—
G17877
SC MEDICAID
—
Enumeration date
09/08/2006
Last updated
08/05/2011
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