Provider Demographics
NPI:1053625962
Name:RONNY J SAYERS MD PC
Entity type:Organization
Organization Name:RONNY J SAYERS MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONNY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SAYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-569-4406
Mailing Address - Street 1:639 VESTAL RD
Mailing Address - Street 2:
Mailing Address - City:SARDIS
Mailing Address - State:GA
Mailing Address - Zip Code:30456-2155
Mailing Address - Country:US
Mailing Address - Phone:478-569-4406
Mailing Address - Fax:478-569-4151
Practice Address - Street 1:639 VESTAL RD
Practice Address - Street 2:
Practice Address - City:SARDIS
Practice Address - State:GA
Practice Address - Zip Code:30456-2155
Practice Address - Country:US
Practice Address - Phone:478-569-4406
Practice Address - Fax:478-569-4151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA24082261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00292421BMedicaid
GA00292421BMedicaid
GA171325716AMedicare PIN