Healthcare Provider Details

I. General information

NPI: 1306859020
Provider Name (Legal Business Name): GHARI N RICHARDSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 06/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4625 RAIN WOOD CIR
VALDOSTA GA
31602-0835
US

IV. Provider business mailing address

4625 RAIN WOOD CIR
VALDOSTA GA
31602-0835
US

V. Phone/Fax

Practice location:
  • Phone: 229-244-3530
  • Fax:
Mailing address:
  • Phone: 229-244-3530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine
License Number207959-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology
License Number059948
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: