Provider Demographics
NPI:1497213748
Name:JOHNSON, RONALD E
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:E
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARL VINSON VA MEDICAL CENTER
Mailing Address - Street 2:1826 VETERANS BLVD.
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021
Mailing Address - Country:US
Mailing Address - Phone:478-272-1210
Mailing Address - Fax:478-277-2874
Practice Address - Street 1:CARL VINSON VA MEDICAL CENTER
Practice Address - Street 2:1826 VETERANS BLVD.
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021
Practice Address - Country:US
Practice Address - Phone:478-272-1210
Practice Address - Fax:478-277-2874
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist