Provider Demographics
NPI:1043311186
Name:RICHARDS, GLORIA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:ANN
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 616788
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32861-6788
Mailing Address - Country:US
Mailing Address - Phone:407-533-6837
Mailing Address - Fax:407-770-0661
Practice Address - Street 1:3571 MARTIN LUTHER KING JR DR SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-4017
Practice Address - Country:US
Practice Address - Phone:470-832-6550
Practice Address - Fax:877-887-6103
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA040770207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG38753Medicare UPIN