Provider Demographics
NPI:1598749160
Name:HART, RONALD R (PHD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:R
Last Name:HART
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1624 FREDERICA ROAD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SAINT SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-2506
Mailing Address - Country:US
Mailing Address - Phone:912-634-1677
Mailing Address - Fax:912-634-1677
Practice Address - Street 1:1624 FREDERICA ROAD
Practice Address - Street 2:SUITE 3
Practice Address - City:SAINT SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-2506
Practice Address - Country:US
Practice Address - Phone:912-634-1677
Practice Address - Fax:912-634-1677
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001838103G00000X, 103T00000X, 103TA0700X, 103TB0200X, 103TC0700X, 103TC1900X, 103TH0004X, 103TH0100X, 103TP2701X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation