Provider Demographics
NPI:1902358104
Name:GHARI RICHARDSON MD FOA PC
Entity Type:Organization
Organization Name:GHARI RICHARDSON MD FOA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GHARI
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-244-3530
Mailing Address - Street 1:3811 OLD US HIGHWAY 41 N
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-6807
Mailing Address - Country:US
Mailing Address - Phone:229-244-3530
Mailing Address - Fax:229-244-1531
Practice Address - Street 1:3811 OLD US HIGHWAY 41 N
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-6807
Practice Address - Country:US
Practice Address - Phone:229-244-3530
Practice Address - Fax:229-244-1531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty