Provider Demographics
NPI:1326280280
Name:SIPE, RICHARD C (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:C
Last Name:SIPE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3231 GLYNN AVE
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4851
Mailing Address - Country:US
Mailing Address - Phone:912-265-9006
Mailing Address - Fax:912-554-3636
Practice Address - Street 1:3231 GLYNN AVE
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4851
Practice Address - Country:US
Practice Address - Phone:912-265-9006
Practice Address - Fax:912-554-3636
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3915OtherMEDICARE GROUP NUMBER
GA357432493AMedicaid
GAGRP3915OtherMEDICARE GROUP NUMBER