Healthcare Provider Details

I. General information

NPI: 1396833620
Provider Name (Legal Business Name): RONALD PAOLINI D. O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 EAST HOSPITAL ROAD ROOM 13A-10
FORT GORDON GA
30905-5650
US

IV. Provider business mailing address

300 EAST HOSPITAL ROAD ROOM 13A-10
FORT GORDON GA
30905-5650
US

V. Phone/Fax

Practice location:
  • Phone: 706-787-0401
  • Fax: 706-787-1327
Mailing address:
  • Phone: 706-787-0401
  • Fax: 706-787-1327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0301X
TaxonomyBrain Injury Medicine (Psychiatry & Neurology) Physician
License Number042687
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2084P0301X
TaxonomyBrain Injury Medicine (Psychiatry & Neurology) Physician
License Number0341
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number4723
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number042687
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberOS-005919-L
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number75297
License Number StateNC
# 7
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number0341
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: