Healthcare Provider Details

I. General information

NPI: 1639163371
Provider Name (Legal Business Name): RONALD EDWARD TRESCOT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 02/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MAGNOLIA CT
MOULTRIE GA
31768-6771
US

IV. Provider business mailing address

PO BOX 3233
MOULTRIE GA
31768-6771
US

V. Phone/Fax

Practice location:
  • Phone: 229-985-2198
  • Fax:
Mailing address:
  • Phone: 229-985-2198
  • Fax: 229-891-3250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number041233
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: