Provider Demographics
NPI:1568553592
Name:STAPPENBECK, RICHARD ALOIS (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALOIS
Last Name:STAPPENBECK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:33 UPPER RIVERDALE RD SW
Mailing Address - Street 2:SUITE 111
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2626
Mailing Address - Country:US
Mailing Address - Phone:770-997-4018
Mailing Address - Fax:770-997-8074
Practice Address - Street 1:33 UPPER RIVERDALE RD SW
Practice Address - Street 2:SUITE 111
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2626
Practice Address - Country:US
Practice Address - Phone:770-997-4018
Practice Address - Fax:770-997-8074
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0208252084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00211648HMedicaid
GA1568553592OtherNPI
GA00211648HMedicaid