Healthcare Provider Details

I. General information

NPI: 1780905588
Provider Name (Legal Business Name): RONALD DAVID ANDERSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2010
Last Update Date: 05/24/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E. HOSPITAL ROAD
FORT EISENHOWER GA
30905
US

IV. Provider business mailing address

300 E. HOSPITAL ROAD
FORT EISENHOWER GA
30905
US

V. Phone/Fax

Practice location:
  • Phone: 706-787-1088
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberFA3089225
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number02003971A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: