Provider Demographics
NPI:1306859020
Name:RICHARDSON, GHARI N (MD)
Entity Type:Individual
Prefix:
First Name:GHARI
Middle Name:N
Last Name:RICHARDSON
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 1:4625 RAIN WOOD CIR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-0835
Mailing Address - Country:US
Mailing Address - Phone:229-244-3530
Mailing Address - Fax:
Practice Address - Street 1:4625 RAIN WOOD CIR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-0835
Practice Address - Country:US
Practice Address - Phone:229-244-3530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207959-1207LP2900X
GA059948207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA134304244BMedicaid
GA134304244CMedicaid
GA134304244CMedicaid
NYRB1408Medicare PIN
NYH31476Medicare UPIN