MEDICARE: RONALD DAVID BLAIR JR. LPAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	APC009301	GA

General Provider Information

NPI Number	:	1538016704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD DAVID BLAIR JR. LPAC

Provider Business Mailing Address
First Line	:	201 DONEHOO ST
Second Line	:
City	:	STATESBORO
State	:	GA
Zip	:	30458-5120
Country	:	US
Telephone Number	:	912-255-3809
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 DONEHOO ST
Second Line	:
City	:	STATESBORO
State	:	GA
Zip	:	30458-5120
Country	:	US
Telephone Number	:	912-255-3809
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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