Healthcare Provider Details

I. General information

NPI: 1275533598
Provider Name (Legal Business Name): RONAL DOWNING GRAHAM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

896 LAFAYETTE ST
RINGGOLD GA
30736-2367
US

IV. Provider business mailing address

896 LAFAYETTE ST
RINGGOLD GA
30736-2367
US

V. Phone/Fax

Practice location:
  • Phone: 706-935-2251
  • Fax: 706-935-5355
Mailing address:
  • Phone: 706-935-2251
  • Fax: 706-935-5355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7724
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: