Provider Demographics
NPI:1609809300
Name:RICKMAN, RICHARD W (MD)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:W
Last Name:RICKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:201 WOODROW WILSON DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2538
Mailing Address - Country:US
Mailing Address - Phone:229-241-0041
Mailing Address - Fax:229-241-0048
Practice Address - Street 1:201 WOODROW WILSON DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602
Practice Address - Country:US
Practice Address - Phone:229-241-0041
Practice Address - Fax:229-241-0048
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA049332207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH33648Medicare UPIN