Provider Demographics
NPI:1255595880
Name:DAVIS, RONALD B (MED)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:B
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3367 EMORY DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-7409
Mailing Address - Country:US
Mailing Address - Phone:678-467-3266
Mailing Address - Fax:770-565-9343
Practice Address - Street 1:295 W CROSSVILLE RD
Practice Address - Street 2:SUITE 740
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-6231
Practice Address - Country:US
Practice Address - Phone:678-467-3266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC001484101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional