Provider Demographics
NPI:1366627887
Name:RONALD S. REAGIN,D.P.M.
Entity Type:Organization
Organization Name:RONALD S. REAGIN,D.P.M.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:REAGIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:912-367-5281
Mailing Address - Street 1:PO BOX 708
Mailing Address - Street 2:
Mailing Address - City:BAXLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31515-0708
Mailing Address - Country:US
Mailing Address - Phone:912-367-5281
Mailing Address - Fax:912-367-5240
Practice Address - Street 1:656 S MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513-0127
Practice Address - Country:US
Practice Address - Phone:912-367-5281
Practice Address - Fax:912-367-5240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000613213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0753530001Medicare NSC