Healthcare Provider Details

I. General information

NPI: 1114938172
Provider Name (Legal Business Name): ROBERT LAWRENCE RICHARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 PEACHTREE INDUSTRIAL BLVD
SUWANEE GA
30024-2013
US

IV. Provider business mailing address

PO BOX 658
GAINESVILLE GA
30503-0658
US

V. Phone/Fax

Practice location:
  • Phone: 678-207-4620
  • Fax: 678-207-4619
Mailing address:
  • Phone: 770-718-1122
  • Fax: 770-533-4786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number050992
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: