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NPI Code Detail

MEDICARE: RON W. COLE PH.D.

MEDICARE: RON W. COLE PH.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
1103TC0700XClinical PsychologistPSY001539GA
2103T00000XPsychologist1539GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1770549776
Entity Type Code : Individual
Provider Name (Legal Business Name) : RON W. COLE PH.D.
Provider Business Mailing Address
First Line : PO BOX 800277
Second Line :
City : LAGRANGE
State : GA
Zip : 30240-0005
Country : US
Telephone Number : 706-594-6073
Fax Number : 706-608-9028
Provider Business Practice Location Address
First Line : 200 N LEWIS ST
Second Line :
City : LAGRANGE
State : GA
Zip : 30240-2738
Country : US
Telephone Number : 706-594-6073
Fax Number : 706-608-9028
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2006
Last Update Date : 09/03/2019

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