Individual
RICHARD JOHN LOCICERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
725 JESSE JEWELL PKWY SE, GAINESVILLE, GA 30501-3834
(770) 297-5700
(770) 718-1877
Mailing address
4605 BROKEN ARROW PATH, GAINESVILLE, GA 30506-7514
(678) 656-8261
Taxonomy
Speciality
Code
Description
License number
State
207RH0000X
Hematology (Internal Medicine) Physician
048535
GA
207RX0202X
Medical Oncology Physician
Primary
048535
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000864498A
—
GA
01
—
10045340
AMERIGROUP
GA
01
—
2993017
CIGNA
GA
01
—
340868
WELLCARE
GA
01
—
3600108
UNITED HEALTHCARE
GA
01
—
52702518
BCBS
GA
01
—
7286112
AETNA
GA
01
—
830007840
RR MEDICARE-GRP # CC4177
GA
Enumeration date
01/20/2006
Last updated
01/25/2024
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