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NPI Code Detail

MEDICARE: DR. RONALD CLINTON ATWATER JR. M.D.

MEDICARE:  DR. RONALD CLINTON ATWATER JR. M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramWA
2208600000XSurgery Physician72406GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104056951
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RONALD CLINTON ATWATER JR. M.D.
Provider Business Mailing Address
First Line : 1178 5TH ST SE
Second Line :
City : CAIRO
State : GA
Zip : 39828-3141
Country : US
Telephone Number : 229-377-2002
Fax Number :
Provider Business Practice Location Address
First Line : 1178 5TH ST SE
Second Line :
City : CAIRO
State : GA
Zip : 39828-3141
Country : US
Telephone Number : 229-377-2002
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2009
Last Update Date : 09/17/2020

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Directions to “ DR. RONALD CLINTON ATWATER JR. M.D.” Practice Location

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