Individual
RICHARD CLARK GILLETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1800 10TH AVE, COLUMBUS, GA 31901-1513
(706) 571-1120
(706) 571-1603
Mailing address
PO BOX 1038, COLUMBUS, GA 31902-1038
(706) 571-1120
(706) 571-1603
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
034142
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000459258E
—
GA
01
—
080154745
RR MEDICARE
—
01
—
52324760 001
BCBS
GA
Enumeration date
09/05/2005
Last updated
08/29/2012
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