Provider Demographics
NPI:1730185596
Name:HART, RONALD L (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:L
Last Name:HART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2878 FIVE FORKS TRICKUM RD
Mailing Address - Street 2:2A
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-5896
Mailing Address - Country:US
Mailing Address - Phone:678-344-8700
Mailing Address - Fax:678-377-8600
Practice Address - Street 1:3685 BRASELTON HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-5920
Practice Address - Country:US
Practice Address - Phone:678-546-9800
Practice Address - Fax:678-344-8600
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2012-04-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA046115207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000841882AFMedicaid
GA000841882AIMedicaid
GA000841882AIMedicaid
H17565Medicare UPIN
08BBRTWMedicare ID - Type Unspecified