Provider Demographics
NPI:1073698031
Name:LINDQUIST, RONALD (PA)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:LINDQUIST
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 MIMOSA DR
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-6605
Mailing Address - Country:US
Mailing Address - Phone:229-227-0045
Mailing Address - Fax:229-227-9120
Practice Address - Street 1:112 MIMOSA DR
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6605
Practice Address - Country:US
Practice Address - Phone:229-227-0045
Practice Address - Fax:229-227-9120
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003926363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11DO266342OtherCLIA LAB NUMBER
GA100002377BMedicaid
GAGRP1474OtherMEDICARE GROUP NUMBER
GAGRP1474OtherMEDICARE GROUP NUMBER
GA100002377BMedicaid