Provider Demographics
NPI:1669708731
Name:BYRD, RONALD JR
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:BYRD
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2214 WALLACE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-1942
Mailing Address - Country:US
Mailing Address - Phone:803-351-8454
Mailing Address - Fax:
Practice Address - Street 1:2214 WALLACE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-1942
Practice Address - Country:US
Practice Address - Phone:803-351-8454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2009-39074-38214171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications