Provider Demographics
NPI:1346663010
Name:CARPENTER, RONISHA (PA-C)
Entity type:Individual
Prefix:
First Name:RONISHA
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 CORNELL AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2701
Mailing Address - Country:US
Mailing Address - Phone:912-785-2100
Mailing Address - Fax:912-368-3868
Practice Address - Street 1:1121 CORNELL AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2701
Practice Address - Country:US
Practice Address - Phone:912-785-2100
Practice Address - Fax:912-368-3868
Is Sole Proprietor?:No
Enumeration Date:2014-01-30
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11185363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant