Provider Demographics
NPI:1063937936
Name:FIELDS, RONNIE
Entity type:Individual
Prefix:
First Name:RONNIE
Middle Name:
Last Name:FIELDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 275
Mailing Address - Street 2:
Mailing Address - City:CLINTWOOD
Mailing Address - State:VA
Mailing Address - Zip Code:24228-0275
Mailing Address - Country:US
Mailing Address - Phone:276-275-0456
Mailing Address - Fax:
Practice Address - Street 1:2234 ROSE RDG
Practice Address - Street 2:
Practice Address - City:CLINTWOOD
Practice Address - State:VA
Practice Address - Zip Code:24228-7738
Practice Address - Country:US
Practice Address - Phone:276-275-0456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-11
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver