Provider Demographics
NPI:1043887144
Name:FAIRS, RONALD B
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:B
Last Name:FAIRS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4921 BOYD DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37218-1609
Mailing Address - Country:US
Mailing Address - Phone:615-707-3543
Mailing Address - Fax:
Practice Address - Street 1:4921 BOYD DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37218-1609
Practice Address - Country:US
Practice Address - Phone:615-707-3543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN66913872172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver