Individual
GARY MICHAEL RICHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3651 WHEELER RD, AUGUSTA, GA 30909-6521
(706) 855-9860
(706) 860-7124
Mailing address
PO BOX 204097, AUGUSTA, GA 30907
(706) 855-9860
(706) 860-7124
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
029293
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000505414C
—
GA
01
—
10065573
AMERIGROUP
GA
05
—
G29293
—
SC
01
—
P00267043
RAILROAD MEDICARE
GA
Enumeration date
04/27/2006
Last updated
01/15/2020
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