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General NPI Number Information
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NPI Number | 1134361512
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Entity Type | Organization
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Legal Business Name | DR. RANCE W. HUMPHREYS, P.C.
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Dates
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Enumeration Date | 03/31/2009
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Last Update Date | 03/31/2009
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Provider Practice Location Address
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Address Line | 1109 BURLEYSON RD SUITE 100
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City | DALTON
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State | GA
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Zip | 30720-3094
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Country | US
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Telephone | 706-529-9614
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Fax | 706-529-9615
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Provider Business Mailing Address
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Address Line | PO BOX 1575
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City | ROCKY FACE
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State | GA
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Zip | 30740-1575
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Country | US
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Telephone | 706-529-9614
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Fax | 706-529-9615
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RANCE WILLIAM HUMPHREYS
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Credential | M.D.
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Telephone | 706-529-9614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 046427
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License Number State | GA
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