Individual
RYAN MICHAEL DECOONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1120 15TH ST, AUGUSTA, GA 30912-1395
(706) 721-8623
Mailing address
1120 15TH STREET, SUITE BI-1056, AUGUSTA, GA 30912-0004
(706) 721-8623
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
070546
GA
207X00000X
Orthopaedic Surgery Physician
MT189277
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070546
GA LICENSE
GA
Enumeration date
12/12/2006
Last updated
05/29/2019
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