Provider Demographics
NPI:1144651456
Name:BURRIS, RONALD WAYNE JR (DC)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:WAYNE
Last Name:BURRIS
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 FOUNDERS ROW
Mailing Address - Street 2:PATHWAYS TO HEALING
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642
Mailing Address - Country:US
Mailing Address - Phone:706-454-2040
Mailing Address - Fax:
Practice Address - Street 1:1022 FOUNDERS ROW
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642-5260
Practice Address - Country:US
Practice Address - Phone:706-454-2040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009209111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor