Provider Demographics
NPI:1083830814
Name:PIRTLE, RONALD C (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:C
Last Name:PIRTLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 IVAN ALLEN JR BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30313-1949
Mailing Address - Country:US
Mailing Address - Phone:404-523-6571
Mailing Address - Fax:404-523-6574
Practice Address - Street 1:239 IVAN ALLEN JR BLVD NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30313-1949
Practice Address - Country:US
Practice Address - Phone:404-523-6571
Practice Address - Fax:404-523-6574
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13784174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00282521DMedicaid
GA00282521DMedicaid