Provider Demographics
NPI:1891952347
Name:RAM UROLOGICAL ASSOCIATES
Entity Type:Organization
Organization Name:RAM UROLOGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:RAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-754-3054
Mailing Address - Street 1:101 ADAMS DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:DEMOREST
Mailing Address - State:GA
Mailing Address - Zip Code:30535-4565
Mailing Address - Country:US
Mailing Address - Phone:706-754-3054
Mailing Address - Fax:706-754-3129
Practice Address - Street 1:101 ADAMS DR
Practice Address - Street 2:SUITE A
Practice Address - City:DEMOREST
Practice Address - State:GA
Practice Address - Zip Code:30535-4565
Practice Address - Country:US
Practice Address - Phone:706-754-3054
Practice Address - Fax:706-754-3129
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAM UROLOGICAL ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-21
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031309208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000376791Medicaid
GA000376791Medicaid