Provider Demographics
NPI:1215014717
Name:TWILLA, RONALD GUY (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:GUY
Last Name:TWILLA
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 1:4039 HIGHLAND ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MILAN
Mailing Address - State:TN
Mailing Address - Zip Code:38358-3483
Mailing Address - Country:US
Mailing Address - Phone:731-686-1516
Mailing Address - Fax:731-686-1518
Practice Address - Street 1:4039 HIGHLAND ST
Practice Address - Street 2:SUITE 5
Practice Address - City:MILAN
Practice Address - State:TN
Practice Address - Zip Code:38358-3483
Practice Address - Country:US
Practice Address - Phone:731-686-1516
Practice Address - Fax:731-686-1518
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000009018207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4535362OtherAETNA
TN0202280OtherBLUECROSS BLUESHIELD
TN3172759Medicaid
TN7794494OtherCIGNA
TN0202280OtherBLUECROSS BLUESHIELD
TN4535362OtherAETNA