Provider Demographics
NPI:1700833787
Name:MEYER, RICHARD DALE (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:DALE
Last Name:MEYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:R
Other - Middle Name:DALE
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 70128
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30007-0128
Mailing Address - Country:US
Mailing Address - Phone:770-578-1800
Mailing Address - Fax:770-578-6168
Practice Address - Street 1:4575 NORTH SHALLOWFORD ROAD
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338
Practice Address - Country:US
Practice Address - Phone:770-454-4286
Practice Address - Fax:770-454-4065
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033404207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E40531Medicare UPIN
GAOSBDKWLMedicare ID - Type Unspecified