Individual
RICHARD A BARDACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 WHITCHER ST NE, SUITE 350, MARIETTA, GA 30060-1155
(770) 424-6893
(770) 528-9938
Mailing address
55 WHITCHER ST NE, SUITE 350, MARIETTA, GA 30060-1155
(770) 424-6893
(770) 528-9938
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
012782
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000132657L
—
GA
05
—
000132657M
—
GA
05
—
000132657N
—
GA
05
—
000132657O
—
GA
05
—
000132657P
—
GA
05
—
000132657Q
—
GA
05
—
000132657R
—
GA
Enumeration date
04/22/2009
Last updated
11/17/2011
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