Healthcare Provider Details

I. General information

NPI: 1992430649
Provider Name (Legal Business Name): RON EAKER MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 CENTRAL AVE STE B
AUGUSTA GA
30904-6246
US

IV. Provider business mailing address

2315 CENTRAL AVE STE B
AUGUSTA GA
30904-6246
US

V. Phone/Fax

Practice location:
  • Phone: 706-842-4210
  • Fax: 706-842-7557
Mailing address:
  • Phone: 706-842-4210
  • Fax: 706-842-7557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VB0002X
TaxonomyObesity Medicine (Obstetrics & Gynecology) Physician
License Number
License Number State

VIII. Authorized Official

Name: RON EAKER
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 706-825-8186