Individual
DR. RONDIE L. ERVIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1775 ACCESS RD, STE. B, COVINGTON, GA 30014-1987
(770) 255-1063
(678) 729-0073
Mailing address
2729 DENNARD RD NE, CONYERS, GA 30013-1181
(678) 413-0552
(678) 729-0073
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
022405
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00433298D
—
GA
01
—
200629861
TAX ID
GA
Enumeration date
07/11/2006
Last updated
06/13/2011
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