Provider Demographics
NPI:1285675488
Name:HERRINGTON, RONALD BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:BRUCE
Last Name:HERRINGTON
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 1:116 W THIGPEN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAKELAND
Mailing Address - State:GA
Mailing Address - Zip Code:31635-1011
Mailing Address - Country:US
Mailing Address - Phone:229-482-2993
Mailing Address - Fax:229-482-2998
Practice Address - Street 1:116 W THIGPEN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:LAKELAND
Practice Address - State:GA
Practice Address - Zip Code:31635-1011
Practice Address - Country:US
Practice Address - Phone:229-482-2993
Practice Address - Fax:229-482-2998
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046118207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11BDSKVMedicare ID - Type Unspecified
GAH20723Medicare UPIN