Provider Demographics
NPI:1467522136
Name:KAISER, RICHARD RALPH (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:RALPH
Last Name:KAISER
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 1:1676 MULKEY RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1170
Mailing Address - Country:US
Mailing Address - Phone:770-941-5107
Mailing Address - Fax:
Practice Address - Street 1:1676 MULKEY RD
Practice Address - Street 2:SUITE C
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1170
Practice Address - Country:US
Practice Address - Phone:770-941-5107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0129262080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00189901AMedicaid