Provider Demographics
NPI:1508987793
Name:HARLEY, RONNIKA C (MD)
Entity Type:Individual
Prefix:DR
First Name:RONNIKA
Middle Name:C
Last Name:HARLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RONNIKA
Other - Middle Name:S
Other - Last Name:COLBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1810 MULKEY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1151
Mailing Address - Country:US
Mailing Address - Phone:770-819-9262
Mailing Address - Fax:770-819-1435
Practice Address - Street 1:1810 MULKEY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1151
Practice Address - Country:US
Practice Address - Phone:770-819-9262
Practice Address - Fax:770-819-1435
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060848208000000X
GARTP 001205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics