Provider Demographics
NPI:1508250333
Name:GILL, RONNIE PRYOR
Entity Type:Individual
Prefix:
First Name:RONNIE
Middle Name:PRYOR
Last Name:GILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RON
Other - Middle Name:
Other - Last Name:GILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BC-HIS
Mailing Address - Street 1:PO BOX 58383
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27658-8383
Mailing Address - Country:US
Mailing Address - Phone:704-747-7611
Mailing Address - Fax:
Practice Address - Street 1:6675 FALLS OF NEUSE RD STE 117
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6803
Practice Address - Country:US
Practice Address - Phone:704-747-7611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1294237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist