MEDICARE: RONDA SHIRLEY

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	106H00000X	Marriage & Family Therapist	MFT001503	GA

General Provider Information

NPI Number	:	1770025678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONDA SHIRLEY

Provider Business Mailing Address
First Line	:	4658 PRESIDENTIAL PKWY # 1264
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31206-8708
Country	:	US
Telephone Number	:	478-951-8776
Fax Number	:

Provider Business Practice Location Address
First Line	:	1813 LONG RIDGE DR
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31211-1611
Country	:	US
Telephone Number	:	478-974-7002
Fax Number	:

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

Provider Enumeration Date	:	11/08/2016
Last Update Date	:	11/26/2024

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Directions to “ RONDA SHIRLEY ” Practice Location

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