Provider Demographics
NPI:1447450465
Name:RONNIE T CHU MD P C
Entity type:Organization
Organization Name:RONNIE T CHU MD P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT OFFICE MANAGER/CREDENTIAL
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:VANN
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-289-9982
Mailing Address - Street 1:P O BOX 306
Mailing Address - Street 2:951 HWY 80 WEST
Mailing Address - City:DEMOPOLIS
Mailing Address - State:AL
Mailing Address - Zip Code:36732-3605
Mailing Address - Country:US
Mailing Address - Phone:334-289-9982
Mailing Address - Fax:334-287-0479
Practice Address - Street 1:951 HIGHWAY 80 W
Practice Address - Street 2:
Practice Address - City:DEMOPOLIS
Practice Address - State:AL
Practice Address - Zip Code:36732
Practice Address - Country:US
Practice Address - Phone:334-289-9982
Practice Address - Fax:334-287-0479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22641173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALJ805OtherMEDICARE PROVIDER NUMBER
AL529916930Medicaid
AL529916930Medicaid