Healthcare Provider Details

I. General information

NPI: 1508987793
Provider Name (Legal Business Name): RONNIKA C HARLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RONNIKA S COLBERT M.D.

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 10/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 MULKEY RD SUITE 201
AUSTELL GA
30106-1151
US

IV. Provider business mailing address

1810 MULKEY RD SUITE 201
AUSTELL GA
30106-1151
US

V. Phone/Fax

Practice location:
  • Phone: 770-819-9262
  • Fax: 770-819-1435
Mailing address:
  • Phone: 770-819-9262
  • Fax: 770-819-1435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number060848
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberRTP 001205
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: