MEDICARE: DR. RICHARD C LODISE M.D.

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	207L00000X	Anesthesiology Physician	030699	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	050030324	OTHER	GA	RAILROAD MEDICARE

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

General Provider Information

NPI Number	:	1942291711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD C LODISE M.D.

Provider Business Mailing Address
First Line	:	1780 W WESLEY RD NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-1910
Country	:	US
Telephone Number	:	404-355-2130
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 ARROWHEAD BLVD
Second Line	:	SUITE C
City	:	JONESBORO
State	:	GA
Zip	:	30236-1254
Country	:	US
Telephone Number	:	770-478-9877
Fax Number	:

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	05/06/2010

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