Healthcare Provider Details

I. General information

NPI: 1891583670
Provider Name (Legal Business Name): RONALD GARY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2025
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 MAYO ST
HILLSBOROUGH NC
27278-2573
US

IV. Provider business mailing address

129 MAYO ST
HILLSBOROUGH NC
27278-2573
US

V. Phone/Fax

Practice location:
  • Phone: 919-910-2001
  • Fax: 336-437-3035
Mailing address:
  • Phone: 919-910-2001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: