Provider Demographics
NPI:1730127689
Name:TERRY, RONALD LYNN (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:LYNN
Last Name:TERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 TANNER BLF
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-3950
Mailing Address - Country:US
Mailing Address - Phone:706-583-9131
Mailing Address - Fax:706-353-2992
Practice Address - Street 1:220 HAWTHORNE PARK
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2148
Practice Address - Country:US
Practice Address - Phone:706-548-0500
Practice Address - Fax:706-353-2992
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0465662085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00808904AMedicaid
GA046566OtherGEORGIA LICENSE
GA046566OtherGEORGIA LICENSE
GA046566OtherGEORGIA LICENSE
GAD92871Medicare UPIN