MEDICARE: DR. RONALD L HART MD

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	207Q00000X	Family Medicine Physician	046115	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730185596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD L HART MD

Provider Business Mailing Address
First Line	:	2878 FIVE FORKS TRICKUM RD
Second Line	:	2A
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30044-5896
Country	:	US
Telephone Number	:	678-344-8700
Fax Number	:	678-377-8600

Provider Business Practice Location Address
First Line	:	3685 BRASELTON HWY
Second Line	:	SUITE 100
City	:	DACULA
State	:	GA
Zip	:	30019-5920
Country	:	US
Telephone Number	:	678-546-9800
Fax Number	:	678-344-8600

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

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	04/09/2012

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