MEDICARE: RONALD ANDERSON

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	225700000X	Massage Therapist	MT008723	GA

General Provider Information

NPI Number	:	1659824605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD ANDERSON

Provider Business Mailing Address
First Line	:	9009 SIX BRANCHES TRL
Second Line	:
City	:	DOUGLASVILLE
State	:	GA
Zip	:	30134-1778
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8046 ROSWELL RD
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30350-7023
Country	:	US
Telephone Number	:	404-857-6881
Fax Number	:

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

Provider Enumeration Date	:	07/26/2016
Last Update Date	:	07/26/2016

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Directions to “ RONALD ANDERSON ” Practice Location

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