Provider Demographics
NPI:1871645226
Name:HARRISON-SPOERL, RONDA R (CP)
Entity Type:Individual
Prefix:DR
First Name:RONDA
Middle Name:R
Last Name:HARRISON-SPOERL
Suffix:
Gender:F
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1378
Mailing Address - Street 2:SW - PATIENT BILLING
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31799-1378
Mailing Address - Country:US
Mailing Address - Phone:229-227-2977
Mailing Address - Fax:229-227-2955
Practice Address - Street 1:400 S PINETREE BLVD
Practice Address - Street 2:PATIENT BILLING DEPT
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-7128
Practice Address - Country:US
Practice Address - Phone:229-227-2977
Practice Address - Fax:229-227-2955
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002862103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ47554Medicare UPIN
GA68BBGNPMedicare ID - Type UnspecifiedMEDICARE