Basic Information
| Provider Information | |||||||||
| NPI: | 1154505659 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RONNIE S. CHRISTIAN, MD, P. C. | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 234 HONOURS DR | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391106514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019568986 | ||||||||
| FaxNumber: | 6622892486 | ||||||||
| Practice Location | |||||||||
| Address1: | 332 HIGHWAY 12 W | ||||||||
| Address2: | |||||||||
| City: | KOSCIUSKO | ||||||||
| State: | MS | ||||||||
| PostalCode: | 390903209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6622891800 | ||||||||
| FaxNumber: | 6622892486 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2007 | ||||||||
| LastUpdateDate: | 12/20/2007 | ||||||||
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| AuthorizedOfficialLastName: | CHRISTIAN | ||||||||
| AuthorizedOfficialFirstName: | RONNIE | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6019568986 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 06391 | MS | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 09016103 | 05 | MS | MEDICAID |