Provider Demographics
NPI:1639144124
Name:RONNINGEN, GEORGIA (CNM)
Entity Type:Individual
Prefix:MS
First Name:GEORGIA
Middle Name:
Last Name:RONNINGEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1791 MULKEY RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1124
Mailing Address - Country:US
Mailing Address - Phone:770-732-5400
Mailing Address - Fax:770-944-0327
Practice Address - Street 1:1791 MULKEY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1124
Practice Address - Country:US
Practice Address - Phone:770-732-5400
Practice Address - Fax:770-944-0327
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN042262363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner