Provider Demographics
NPI:1295790194
Name:SHINAULT, RON (ATC)
Entity type:Individual
Prefix:
First Name:RON
Middle Name:
Last Name:SHINAULT
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 HARDIN DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-1520
Mailing Address - Country:US
Mailing Address - Phone:706-583-8074
Mailing Address - Fax:
Practice Address - Street 1:100 SMITH ST
Practice Address - Street 2:STEGEMAN COLISUEM
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30603-1472
Practice Address - Country:US
Practice Address - Phone:706-583-8074
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT008722255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer