Provider Demographics
NPI:1881104180
Name:NURSE, RONALD ANTHONY
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:ANTHONY
Last Name:NURSE
Suffix:
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:PO BOX 14332
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30919-0332
Mailing Address - Country:US
Mailing Address - Phone:706-627-4285
Mailing Address - Fax:706-723-9233
Practice Address - Street 1:2905 ARROWHEAD DR APT E7
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-2062
Practice Address - Country:US
Practice Address - Phone:706-627-4285
Practice Address - Fax:706-723-9233
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X, 104100000X, 175T00000X, 106S00000X
GA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No175T00000XOther Service ProvidersPeer Specialist