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NPI Code Detail

MEDICARE: RICHARD CLARK GILLETT M.D.

MEDICARE: RICHARD CLARK GILLETT M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician034142GA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3080154745OTHERRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
152324760 001OTHERGABCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134113277
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD CLARK GILLETT M.D.
Provider Business Mailing Address
First Line : PO BOX 1038
Second Line :
City : COLUMBUS
State : GA
Zip : 31902-1038
Country : US
Telephone Number : 706-571-1120
Fax Number : 706-571-1603
Provider Business Practice Location Address
First Line : 1800 10TH AVE
Second Line :
City : COLUMBUS
State : GA
Zip : 31901-1513
Country : US
Telephone Number : 706-571-1120
Fax Number : 706-571-1603
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2005
Last Update Date : 08/29/2012

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