Provider Demographics
NPI:1548282551
Name:RUCH, JOHN A (DPM)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:RUCH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 VILLAGE GREEN CIR SE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-3476
Mailing Address - Country:US
Mailing Address - Phone:770-384-0284
Mailing Address - Fax:770-432-7638
Practice Address - Street 1:2193 NORTHLAKE PKWY
Practice Address - Street 2:STE 114
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4116
Practice Address - Country:US
Practice Address - Phone:770-938-5974
Practice Address - Fax:770-939-7393
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA407213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
406480290OtherMCR RAILROAD
GA00115519AMedicaid
237428OtherBLUE CROSS
518145OtherAETNA
GA58-1994261OtherTAX ID NUMBER
GA48SCCWJMedicare PIN
237428OtherBLUE CROSS
518145OtherAETNA
GA1103400020Medicare NSC