Provider Demographics
NPI:1487652285
Name:HIGHTOWER, RICHARD RUSSELL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:RUSSELL
Last Name:HIGHTOWER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1000 TOWNE CENTER BLVD BLDG 1200
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-4129
Mailing Address - Country:US
Mailing Address - Phone:912-748-2280
Mailing Address - Fax:912-748-4988
Practice Address - Street 1:1000 TOWNE CENTER BLVD BLDG 1200
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4129
Practice Address - Country:US
Practice Address - Phone:912-748-2280
Practice Address - Fax:912-748-4988
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA39367207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000842861BMedicaid
GA925527OtherBCBS
SCG39367Medicaid
GAP00168254OtherRR MEDICARE
GA000842861CMedicaid