Healthcare Provider Details

I. General information

NPI: 1790779569
Provider Name (Legal Business Name): RONALD JOHN SAVOY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S TWINING ST 42ND MDG, ATTN:CREDENTIALS
MONTGOMERY AL
36112
US

IV. Provider business mailing address

731 RED EAGLE RD
PRATTVILLE AL
36067-7042
US

V. Phone/Fax

Practice location:
  • Phone: 334-953-7567
  • Fax: 334-953-4214
Mailing address:
  • Phone: 334-365-3405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA-171
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: