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General NPI Number Information
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NPI Number | 1194252783
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Entity Type | Individual
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Provider Name | RONALD SOELIMTO PMHNP
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Gender | Male
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Dates
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Enumeration Date | 05/15/2017
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 5965 PARKWAY NORTH BLVD STE C
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City | CUMMING
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State | GA
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Zip | 30040-1431
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Country | US
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Telephone | 770-886-5700
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Fax | 770-886-0404
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Provider Business Mailing Address
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Address Line | 5965 PARKWAY NORTH BLVD STE C
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City | CUMMING
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State | GA
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Zip | 30040-1431
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Country | US
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Telephone | 770-886-5700
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Fax | 770-886-0404
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN-NP293788
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License Number State | GA
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