Provider Demographics
NPI:1356226088
Name:SMITH, RONALD
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 TOWNE PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-9369
Mailing Address - Country:US
Mailing Address - Phone:912-208-4776
Mailing Address - Fax:
Practice Address - Street 1:806 TOWNE PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-9369
Practice Address - Country:US
Practice Address - Phone:912-208-4776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician