Provider Demographics
NPI:1144213075
Name:MELCHER, RICHARD E (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:E
Last Name:MELCHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 371
Mailing Address - Street 2:
Mailing Address - City:WRIGHTSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31096-0371
Mailing Address - Country:US
Mailing Address - Phone:478-864-3448
Mailing Address - Fax:478-864-1288
Practice Address - Street 1:1008 ATLANTA HWY
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:GA
Practice Address - Zip Code:30828-9109
Practice Address - Country:US
Practice Address - Phone:706-465-3253
Practice Address - Fax:706-465-3256
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018526207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000302068IMedicaid
GA111813OtherMEDICARE FQHC
GA341629OtherWELLCARE
GA341630OtherWELLCARE
GA111811OtherMEDICARE FQHC
GA08BDMNGOtherMEDICARE FFS
GA341628OtherWELLCARE
GA10057285OtherAMERIGROUP
GAGRP1619OtherMEDICARE GROUP FFS
GA000302068GMedicaid
080150840OtherMEDICARE RR RETIRED
GA000302068KMedicaid
GA111812OtherMEDICARE FQHC
GA111814OtherMEDICARE FQHC
GA342410OtherWELLCARE
GA111811OtherMEDICARE FQHC