Provider Demographics
NPI:1730145327
Name:DIRUGGIERO, DOUGLAS C JR (PAC)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:C
Last Name:DIRUGGIERO
Suffix:JR
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:DOUGLAS
Other - Middle Name:C
Other - Last Name:DIRUGGIERO
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:PAC
Mailing Address - Street 1:136 BATTLEFIELD CROSSING CT
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-5176
Mailing Address - Country:US
Mailing Address - Phone:706-277-7311
Mailing Address - Fax:706-529-7210
Practice Address - Street 1:9 MEDICAL DR NE
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30121-8003
Practice Address - Country:US
Practice Address - Phone:470-227-1600
Practice Address - Fax:470-227-1606
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003061363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA534385262LMedicaid
GA534385262CMedicaid
GAS84570Medicare UPIN
GA534385262CMedicaid