Healthcare Provider Details

I. General information

NPI: 1558351437
Provider Name (Legal Business Name): RICHARD D FERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 10/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 WEST 8TH STREET
ROME GA
30165
US

IV. Provider business mailing address

311 WEST 8TH STREET
ROME GA
30165
US

V. Phone/Fax

Practice location:
  • Phone: 706-291-8702
  • Fax: 706-291-6514
Mailing address:
  • Phone: 706-291-8702
  • Fax: 706-291-6514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License NumberME004673
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberME004673
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License NumberME004673
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207ZI0100X
TaxonomyImmunopathology Physician
License NumberME0046703
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberME004673
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code207ZM0300X
TaxonomyMedical Microbiology Physician
License NumberME0046703
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code207ZP0104X
TaxonomyChemical Pathology Physician
License NumberME004673
License Number StateFL
# 8
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number78559
License Number StateGA
# 9
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME004673
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: