MEDICARE: DR. RICHARD RANDALL MCNEELY DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN015885	GA

General Provider Information

NPI Number	:	1053971028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD RANDALL MCNEELY DMD

Provider Business Mailing Address
First Line	:	22 DEER RUN TRCE
Second Line	:
City	:	SWAINSBORO
State	:	GA
Zip	:	30401-4450
Country	:	US
Telephone Number	:	478-494-9654
Fax Number	:

Provider Business Practice Location Address
First Line	:	1725 DAWSON RD
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31707-3362
Country	:	US
Telephone Number	:	229-883-7891
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2019
Last Update Date	:	06/20/2019

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