Individual
RICHARD D SHACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3400 C OLD MILTON PARKWAY, SUITE 270, ALPHARETTA, GA 30005
(770) 442-1911
(770) 663-8905
Mailing address
3400 C OLD MILTON PARKWAY, SUITE 270, ALPHARETTA, GA 30005
(770) 442-1911
(770) 663-8905
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
061856
GA
207Q00000X
Family Medicine Physician
22858
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009960760
—
AL
01
—
051502030
BCBS
AL
Enumeration date
08/17/2006
Last updated
06/09/2015
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