Basic Information
| Provider Information | |||||||||
| NPI: | 1366862229 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAY | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | |||||||||
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| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | MAY | ||||||||
| OtherFirstName: | RICHARD | ||||||||
| OtherMiddleName: | GREGORY | ||||||||
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| OtherCredential: | DO | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 975 E. THIRD STREET | ||||||||
| Address2: | ATTN: PROVIDER ENROLLMENT | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7068208133 | ||||||||
| FaxNumber: | 7068208134 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 MCFARLAND RD | ||||||||
| Address2: | |||||||||
| City: | LOOKOUT MOUNTAIN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307503121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7068208133 | ||||||||
| FaxNumber: | 7068208134 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2014 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 3186 | TN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 078420 | GA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.