Provider Demographics
NPI:1003011578
Name:RICHARDSON, GAA ODETTA (MD)
Entity Type:Individual
Prefix:DR
First Name:GAA
Middle Name:ODETTA
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:415 N CENTER ST
Mailing Address - Street 2:STE. 300
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-5057
Mailing Address - Country:US
Mailing Address - Phone:828-328-3300
Mailing Address - Fax:828-328-9101
Practice Address - Street 1:415 N CENTER ST
Practice Address - Street 2:SUITE 300
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-5057
Practice Address - Country:US
Practice Address - Phone:828-328-3300
Practice Address - Fax:828-328-9101
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004024412207RG0100X
NC2008-00566207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2022263AMedicare PIN