Healthcare Provider Details

I. General information

NPI: 1356965255
Provider Name (Legal Business Name): RICHARD STEVEN MENEAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 CLIFTON RD NE
ATLANTA GA
30322-1059
US

IV. Provider business mailing address

1001 E BAYAUD AVE APT 1802
DENVER CO
80209-2378
US

V. Phone/Fax

Practice location:
  • Phone: 404-712-2000
  • Fax:
Mailing address:
  • Phone: 770-365-1950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN296585
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN.0201695
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: