Individual
RICHARD NEIL BANEY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2124 CANDLER RD, DECATUR, GA 30032-5572
(404) 836-0272
Mailing address
1395 NW 167TH ST, MIAMI GARDENS, FL 33169-5710
(770) 629-3217
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
89132
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110117266
RR MEDICARE
FL
05
—
379634500
—
FL
Enumeration date
08/29/2005
Last updated
05/02/2022
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