Provider Demographics
NPI:1447346721
Name:MONTALVO, RUTH DATMARE (MD)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:DATMARE
Last Name:MONTALVO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2740 RAY KNIGHT WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-0226
Mailing Address - Country:US
Mailing Address - Phone:229-312-0698
Mailing Address - Fax:229-438-7898
Practice Address - Street 1:2740 RAY KNIGHT WAY STE 100
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-0226
Practice Address - Country:US
Practice Address - Phone:229-312-0698
Practice Address - Fax:229-438-7898
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207RG0100X207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003123270EMedicaid
GA003123270EMedicaid
TN3000028Medicare PIN