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General NPI Number Information
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NPI Number | 1770025678
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Entity Type | Individual
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Provider Name | RONDA SHIRLEY
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Gender | Female
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Dates
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Enumeration Date | 11/08/2016
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 1813 LONG RIDGE DR
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City | MACON
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State | GA
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Zip | 31211-1611
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Country | US
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Telephone | 478-974-7002
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Fax |
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Provider Business Mailing Address
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Address Line | 4658 PRESIDENTIAL PKWY # 1264
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City | MACON
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State | GA
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Zip | 31206-8708
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Country | US
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Telephone | 478-951-8776
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT001503
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License Number State | GA
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