Provider Demographics
NPI:1922015254
Name:ADAMS, RONALD GARY (OTR/L, CHT)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:GARY
Last Name:ADAMS
Suffix:
Gender:M
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:RON
Other - Middle Name:
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L, CHT
Mailing Address - Street 1:2227 US HIGHWAY 41 N
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-2749
Mailing Address - Country:US
Mailing Address - Phone:229-353-6188
Mailing Address - Fax:
Practice Address - Street 1:2227 US HIGHWAY 41 N
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-2749
Practice Address - Country:US
Practice Address - Phone:229-353-6188
Practice Address - Fax:229-353-6309
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT 001975225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000919542AMedicaid
GA299035410AMedicaid
GA299035410BMedicaid
GA299035410BMedicaid
GAP27798Medicare UPIN