Healthcare Provider Details

I. General information

NPI: 1730280975
Provider Name (Legal Business Name): RONNIE R FELTS DPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7164 WHITES CREEK PIKE
JOELTON TN
37080-8632
US

IV. Provider business mailing address

7164 WHITES CREEK PIKE
JOELTON TN
37080-8632
US

V. Phone/Fax

Practice location:
  • Phone: 615-876-0633
  • Fax: 615-876-0080
Mailing address:
  • Phone: 615-876-0633
  • Fax: 615-876-0080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3733
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: