Individual
MRS. WANDA THORNTON RUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
215 EDMONDSON WAY, FAYETTEVILLE, GA 30214-7258
(770) 460-9078
Mailing address
215 EDMONDSON WAY, FAYETTEVILLE, GA 30214-7258
(770) 460-9078
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
01/27/2016
Last updated
01/27/2016
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