Provider Demographics
NPI: | 1700241304 |
---|---|
Name: | GILBERT, RONNIE CARL (RN) |
Entity Type: | Individual |
Prefix: | MR |
First Name: | RONNIE |
Middle Name: | CARL |
Last Name: | GILBERT |
Suffix: | |
Gender: | M |
Credentials: | RN |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 150 BOUNDARY TREE DR |
Mailing Address - Street 2: | |
Mailing Address - City: | ELLENWOOD |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 30294-3242 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 678-438-4947 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 150 BOUNDARY TREE DR |
Practice Address - Street 2: | |
Practice Address - City: | ELLENWOOD |
Practice Address - State: | GA |
Practice Address - Zip Code: | 30294-3242 |
Practice Address - Country: | US |
Practice Address - Phone: | 678-438-4947 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2015-12-23 |
Last Update Date: | 2015-12-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
GA | RN151505 | 163W00000X, 163WA0400X, 163WC0400X, 163WC1400X, 163WC1500X, 163WC1600X, 163WC2100X, 163WC3500X, 163WG0600X, 163WH0200X, 163WI0500X, 163WN1003X, 163WP0000X, 163WR0400X, 163WX0106X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 163W00000X | Nursing Service Providers | Registered Nurse | |
No | 163WA0400X | Nursing Service Providers | Registered Nurse | Addiction (Substance Use Disorder) |
No | 163WC0400X | Nursing Service Providers | Registered Nurse | Case Management |
No | 163WC1400X | Nursing Service Providers | Registered Nurse | College Health |
No | 163WC1500X | Nursing Service Providers | Registered Nurse | Community Health |
No | 163WC1600X | Nursing Service Providers | Registered Nurse | Continuing Education/Staff Development |
No | 163WC2100X | Nursing Service Providers | Registered Nurse | Continence Care |
No | 163WC3500X | Nursing Service Providers | Registered Nurse | Cardiac Rehabilitation |
No | 163WG0600X | Nursing Service Providers | Registered Nurse | Gerontology |
No | 163WH0200X | Nursing Service Providers | Registered Nurse | Home Health |
No | 163WI0500X | Nursing Service Providers | Registered Nurse | Infusion Therapy |
No | 163WN1003X | Nursing Service Providers | Registered Nurse | Nutrition Support |
No | 163WP0000X | Nursing Service Providers | Registered Nurse | Pain Management |
No | 163WR0400X | Nursing Service Providers | Registered Nurse | Rehabilitation |
No | 163WX0106X | Nursing Service Providers | Registered Nurse | Occupational Health |