Healthcare Provider Details

I. General information

NPI: 1154505659
Provider Name (Legal Business Name): RONNIE S. CHRISTIAN, MD, P. C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 12/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 HIGHWAY 12 W
KOSCIUSKO MS
39090-3209
US

IV. Provider business mailing address

234 HONOURS DR
MADISON MS
39110-6514
US

V. Phone/Fax

Practice location:
  • Phone: 662-289-1800
  • Fax: 662-289-2486
Mailing address:
  • Phone: 601-956-8986
  • Fax: 662-289-2486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number06391
License Number StateMS

VIII. Authorized Official

Name: DR. RONNIE S CHRISTIAN
Title or Position: OWNER
Credential: MD
Phone: 601-956-8986