Provider Demographics
NPI:1114910510
Name:RAM, BERNARD A (MD)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:A
Last Name:RAM
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 1:58 BIG A ROAD
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-6017
Mailing Address - Country:US
Mailing Address - Phone:706-886-3151
Mailing Address - Fax:706-282-7781
Practice Address - Street 1:58 BIG A ROAD
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-6017
Practice Address - Country:US
Practice Address - Phone:706-886-3151
Practice Address - Fax:706-282-7781
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA31309208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000376791BMedicaid
GA000376791BMedicaid
GAC81585Medicare UPIN