Ronald Blaine Everson, PH.D.
Individual provider Active NPI Marriage & Family Therapist · Bogart, GA
NPI 1720113434 · NPPES record last updated Mar 7, 2013
Key facts
- NPI
- 1720113434
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- 000776 (GA)
- Practice address
- 1361 Jennings Mill Rd
Suite 201
Bogart, GA 30622-2579 - Phone
- (706) 316-1908
- Fax
- (706) 316-2026
- NPI assigned
- Feb 22, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000776 | GA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Athens Behavioral Medicine | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 000776 | GA | Yes |
Addresses
Primary practice location
1361 Jennings Mill Rd
Suite 201
Bogart, GA 30622-2579
Mailing address
1361 Jennings Mill Rd
Suite 201
Bogart, GA 30622-2579
Phone (706) 316-1908
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 793969025A | Medicaid | GA |
Other providers in Bogart, GA
- Edg Logistics, LLC
- Edward J Fisher Jr MD Inc
- Anna M Edwards-Gaura
- Cathy Smith Elkins
- Amber L Emard
- Families 4 Change, Inc.
- Edward J Fisher Jr.
- Sarah Gay
- Robert Lawrence George
- Georgia Options, Inc.
All providers in Bogart, GA · Marriage & Family Therapist in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.