Provider Demographics
NPI:1689632093
Name:FIELD, RICHARD SHAFTER (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:SHAFTER
Last Name:FIELD
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 1:811 13TH ST
Mailing Address - Street 2:SUITE 14
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2700
Mailing Address - Country:US
Mailing Address - Phone:706-828-0043
Mailing Address - Fax:706-828-0450
Practice Address - Street 1:811 13TH ST
Practice Address - Street 2:SUITE 14
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2700
Practice Address - Country:US
Practice Address - Phone:706-828-0043
Practice Address - Fax:706-828-0450
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028541207RR0500X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD39846Medicare UPIN