MEDICARE: MR. RICHARD JOHN LIOTTA D.O

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	207Q00000X	Family Medicine Physician	036408	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0100402	OTHER	GA	UNITED HEALTHCARE
3	752850	OTHER	GA	BLUE CROSS BLUE SHIELD
4	0880369013	OTHER	GA	CIGNA HEALTHCARE
5	4607419	OTHER	GA	AETNA MANAGED CARE
6	513138	OTHER	GA	AETNA HMO

General Provider Information

NPI Number	:	1619927522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD JOHN LIOTTA D.O

Provider Business Mailing Address
First Line	:	4585 NELSON BROGDON BLVD
Second Line	:
City	:	SUGARHILL
State	:	GA
Zip	:	30518-3466
Country	:	US
Telephone Number	:	770-932-0547
Fax Number	:	770-932-4035

Provider Business Practice Location Address
First Line	:	4585 NELSON BROGDON BLVD
Second Line	:
City	:	SUGARHILL
State	:	GA
Zip	:	30518-3466
Country	:	US
Telephone Number	:	770-932-0547
Fax Number	:	770-932-4035

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	03/18/2010

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Directions to “ MR. RICHARD JOHN LIOTTA D.O” Practice Location

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