Provider Demographics
NPI:1093758294
Name:AUSTIN, RALPH JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:
Last Name:AUSTIN
Suffix:JR
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 1:644 TALLULAH TRL
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-7625
Mailing Address - Country:US
Mailing Address - Phone:478-333-2100
Mailing Address - Fax:478-333-5201
Practice Address - Street 1:644 TALLULAH TRL
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-7625
Practice Address - Country:US
Practice Address - Phone:478-333-2100
Practice Address - Fax:478-333-5201
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA021140207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD44754Medicare UPIN