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NPI Code Detail

MEDICARE: MR. RICHARD G SLIPKOVICH P.A.

MEDICARE: MR. RICHARD G SLIPKOVICH P.A.
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
1363A00000XPhysician Assistant001439GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407900335
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RICHARD G SLIPKOVICH P.A.
Provider Business Mailing Address
First Line : 211 FAIRVIEW RD
Second Line :
City : ELLENWOOD
State : GA
Zip : 30294-2721
Country : US
Telephone Number : 770-507-4554
Fax Number : 770-507-6413
Provider Business Practice Location Address
First Line : 211 FAIRVIEW RD
Second Line :
City : ELLENWOOD
State : GA
Zip : 30294-2721
Country : US
Telephone Number : 770-507-4554
Fax Number : 770-507-6413
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2007
Last Update Date : 03/31/2008

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