Provider Demographics
NPI:1548422090
Name:CASCADE INTERNAL MEDICINE
Entity Type:Organization
Organization Name:CASCADE INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-691-6145
Mailing Address - Street 1:3915 CASCADE RD SW
Mailing Address - Street 2:STE 330
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-8512
Mailing Address - Country:US
Mailing Address - Phone:404-691-6145
Mailing Address - Fax:404-691-6445
Practice Address - Street 1:3915 CASCADE RD SW
Practice Address - Street 2:STE 330
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-8512
Practice Address - Country:US
Practice Address - Phone:404-691-6145
Practice Address - Fax:404-691-6445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040770207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG38753Medicare UPIN