Provider Demographics
NPI:1780208421
Name:SUMPTER, RONALD GENE
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:GENE
Last Name:SUMPTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 OLD HALIFAX RD STE H
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-4915
Mailing Address - Country:US
Mailing Address - Phone:336-988-3966
Mailing Address - Fax:
Practice Address - Street 1:3401 OLD HALIFAX RD STE H
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-4915
Practice Address - Country:US
Practice Address - Phone:336-988-3966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3168046172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver