Provider Demographics
NPI:1013983162
Name:RICH, DARLA (NP)
Entity Type:Individual
Prefix:
First Name:DARLA
Middle Name:
Last Name:RICH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 PINE ST
Mailing Address - Street 2:STE 510
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-7530
Mailing Address - Country:US
Mailing Address - Phone:478-633-8383
Mailing Address - Fax:478-633-8390
Practice Address - Street 1:770 PINE ST STE 210
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-7512
Practice Address - Country:US
Practice Address - Phone:478-633-8383
Practice Address - Fax:478-633-8390
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN063754363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000969933BMedicaid
GA000969933BMedicaid