Provider Demographics
NPI:1417901216
Name:MANSFIELD, RICHARD HARRIS (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:HARRIS
Last Name:MANSFIELD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 BROOKSTONE CENTRE PKWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-4572
Mailing Address - Country:US
Mailing Address - Phone:706-571-9699
Mailing Address - Fax:706-571-9565
Practice Address - Street 1:2001 BROOKSTONE CENTRE PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-4572
Practice Address - Country:US
Practice Address - Phone:706-571-9699
Practice Address - Fax:706-571-9565
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044526208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
5160931003OtherCIGNA
GA37BBGDKMedicare ID - Type Unspecified
5160931003OtherCIGNA