Provider Demographics
NPI:1528065406
Name:LOCKE, RONALD NEWTON (MD)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:NEWTON
Last Name:LOCKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:204 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:GA
Mailing Address - Zip Code:31510-2908
Mailing Address - Country:US
Mailing Address - Phone:912-632-2952
Mailing Address - Fax:912-632-8682
Practice Address - Street 1:1406 HABERSHAM DR
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-5306
Practice Address - Country:US
Practice Address - Phone:912-287-1130
Practice Address - Fax:912-287-9114
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9501318208600000X
GA85922208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8952429Medicaid
NC52429OtherBCBS NC
NC5768353OtherCIGNA
NCC2338OtherMEDCOST
D17722Medicare UPIN
NCC2338OtherMEDCOST