1730185596 NPI number — DR. RONALD L HART MD

Table of content: DR. RONALD L HART MD (NPI 1730185596)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730185596 NPI number — DR. RONALD L HART MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HART
Provider First Name:
RONALD
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730185596
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2878 FIVE FORKS TRICKUM RD
Provider Second Line Business Mailing Address:
2A
Provider Business Mailing Address City Name:
LAWRENCEVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30044-5896
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-344-8700
Provider Business Mailing Address Fax Number:
678-377-8600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3685 BRASELTON HWY
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
DACULA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30019-5920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-546-9800
Provider Business Practice Location Address Fax Number:
678-344-8600
Provider Enumeration Date:
06/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  046115 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000841882AF , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000841882AI , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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