Provider Demographics
NPI:1174637532
Name:DEVINE, RONALD EUGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:EUGENE
Last Name:DEVINE
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 1:275 COLLIER RD NW
Mailing Address - Street 2:STE 450
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1709
Mailing Address - Country:US
Mailing Address - Phone:404-355-3161
Mailing Address - Fax:404-355-1353
Practice Address - Street 1:275 COLLIER RD NW
Practice Address - Street 2:STE 450
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1709
Practice Address - Country:US
Practice Address - Phone:404-355-3161
Practice Address - Fax:404-355-1353
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA51311207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000961078AMedicaid
GA51311OtherGA STATE MEDICAL LICENSE
GABD5987574OtherDEA LICENSE
GA51311OtherGA STATE MEDICAL LICENSE