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General NPI Number Information
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NPI Number | 1427064583
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Entity Type | Individual
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Provider Name | RICHARD PROKESCH M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 09/15/2008
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Provider Practice Location Address
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Address Line | 6285 GARDEN WALK BLVD STE A
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City | RIVERDALE
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State | GA
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Zip | 30274-2612
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Country | US
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Telephone | 770-991-1150
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Fax | 770-991-9047
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Provider Business Mailing Address
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Address Line | 6285 GARDEN WALK BLVD STE A
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City | RIVERDALE
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State | GA
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Zip | 30274-2612
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Country | US
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Telephone | 770-991-1150
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Fax | 770-991-9047
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 019754
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License Number State | GA
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