Provider Demographics
NPI:1023746203
Name:GUY, RICHARD ALLEN
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALLEN
Last Name:GUY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4116
Mailing Address - Country:US
Mailing Address - Phone:601-938-9843
Mailing Address - Fax:
Practice Address - Street 1:13 LAKE EDDINS 16384A
Practice Address - Street 2:
Practice Address - City:PACHUTA
Practice Address - State:MS
Practice Address - Zip Code:39347-5167
Practice Address - Country:US
Practice Address - Phone:601-938-9843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty