Provider Demographics
NPI:1275699910
Name:SMITH, RONAL EUGENE (PHD)
Entity Type:Individual
Prefix:DR
First Name:RONAL
Middle Name:EUGENE
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:SIGNAL MOUNTAIN
Mailing Address - State:TN
Mailing Address - Zip Code:37377-0005
Mailing Address - Country:US
Mailing Address - Phone:423-886-7761
Mailing Address - Fax:423-886-5035
Practice Address - Street 1:35 HARLEY LN
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-7391
Practice Address - Country:US
Practice Address - Phone:706-994-0350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000001514103TC2200X, 103TC0700X
GAPSY001390103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000424652AMedicaid
GA000424652CMedicaid
TN3680031Medicare PIN