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1629072699

NPI Code Detail

MEDICARE: RICHARD L INGRAM MD

MEDICARE: RICHARD L INGRAM MD

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	207RN0300X	Nephrology Physician	026563	GA
2	207R00000X	Internal Medicine Physician	026563	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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629072699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD L INGRAM MD

Provider Business Mailing Address
First Line	:	1602 VERNON RD
Second Line	:	STE 400
City	:	LAGRANGE
State	:	GA
Zip	:	30240-4100
Country	:	US
Telephone Number	:	706-882-9341
Fax Number	:	706-884-0131

Provider Business Practice Location Address
First Line	:	1602 VERNON RD
Second Line	:	STE 400
City	:	LAGRANGE
State	:	GA
Zip	:	30240-4100
Country	:	US
Telephone Number	:	706-882-9341
Fax Number	:	706-884-0131

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	04/15/2024

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Directions to “ RICHARD L INGRAM MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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