Healthcare Provider Details

I. General information

NPI: 1306873427
Provider Name (Legal Business Name): RONALD HUET MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 LAKE OCONEE PKWY
EATONTON GA
31024-6054
US

IV. Provider business mailing address

408 WINGED FOOT DR
MCDONOUGH GA
30253-4251
US

V. Phone/Fax

Practice location:
  • Phone: 904-805-1300
  • Fax: 904-805-1302
Mailing address:
  • Phone: 678-773-0582
  • Fax: 904-805-1302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number26784
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number26784
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: