Provider Demographics
NPI:1841258662
Name:CUNNINGHAM, RICHARD RAY (DO)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:RAY
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 S. COLLEGE ST.
Mailing Address - Street 2:SUITE 108-C
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36832
Mailing Address - Country:US
Mailing Address - Phone:256-263-0162
Mailing Address - Fax:256-781-0161
Practice Address - Street 1:1100 S. COLLEGE ST.
Practice Address - Street 2:SUITE 108-C
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36832
Practice Address - Country:US
Practice Address - Phone:256-263-0162
Practice Address - Fax:256-781-0161
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA79987207Q00000X
ALDO 929207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009938947Medicaid
AL529929690Medicaid
AL051557598Medicare ID - Type Unspecified
FL46535YMedicare ID - Type Unspecified
AL009938947Medicaid