Provider Demographics
NPI:1376376913
Name:LITTLE, DAVID RICHARDSON
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:RICHARDSON
Last Name:LITTLE
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 1:205 MARTIN LUTHER KING JR RD
Mailing Address - Street 2:
Mailing Address - City:IRWINTON
Mailing Address - State:GA
Mailing Address - Zip Code:31042-2839
Mailing Address - Country:US
Mailing Address - Phone:478-290-5485
Mailing Address - Fax:
Practice Address - Street 1:205 MARTIN LUTHER KING JR RD
Practice Address - Street 2:
Practice Address - City:IRWINTON
Practice Address - State:GA
Practice Address - Zip Code:31042-2839
Practice Address - Country:US
Practice Address - Phone:478-290-5485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Multi-Specialty