Provider Demographics
NPI:1871909754
Name:ERICKSON, RON GLENN
Entity type:Individual
Prefix:
First Name:RON
Middle Name:GLENN
Last Name:ERICKSON
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 1:178 CARRONBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-2699
Mailing Address - Country:US
Mailing Address - Phone:615-926-7347
Mailing Address - Fax:
Practice Address - Street 1:100 OXMOOR BLVD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-5948
Practice Address - Country:US
Practice Address - Phone:615-926-7347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-11
Last Update Date:2015-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver