Provider Demographics
NPI:1053393595
Name:MACBETH, RONALD A JR (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:A
Last Name:MACBETH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-3139
Mailing Address - Country:US
Mailing Address - Phone:706-439-6858
Mailing Address - Fax:828-835-3486
Practice Address - Street 1:19 DOCTORS WAY
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512
Practice Address - Country:US
Practice Address - Phone:706-439-6858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA049310174400000X
GA049310207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000894187GMedicaid
GA000894187GMedicaid
GA202I200657Medicare UPIN
FL15108YMedicare PIN