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General NPI Number Information
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NPI Number | 1083825343
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Entity Type | Organization
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Legal Business Name | RONALD E HARRELL DDS PC
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 217 SOUTH WOOLFORK AVENUE
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City | DONALSONVILLE
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State | GA
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Zip | 39845-1638
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Country | US
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Telephone | 229-524-5669
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Fax | 229-524-6076
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Provider Business Mailing Address
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Address Line | 217 SOUTH WOOLFORK AVENUE
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City | DONALSONVILLE
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State | GA
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Zip | 39845-1638
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Country | US
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Telephone | 229-524-5669
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Fax | 229-524-6076
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Authorized Official
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Title or Position | PRESIDENT CEO
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Name | DR. RONALD E HARRELL
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Credential | DDS
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Telephone | 229-524-5669
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN006325
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License Number State | GA
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