Provider Demographics
NPI:1073168522
Name:RHODES, RICHARD (NP-C)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:RHODES
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5243 PIKES PEAK CT
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-6557
Mailing Address - Country:US
Mailing Address - Phone:607-227-8192
Mailing Address - Fax:
Practice Address - Street 1:2155 POST OAK TRITT RD STE 100
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-1651
Practice Address - Country:US
Practice Address - Phone:770-973-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF02190838208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics