Basic Information
| Provider Information | |||||||||
| NPI: | 1710293881 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RICHARDSON | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | MEADE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 N COLLEGE ST | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 360372025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3343822681 | ||||||||
| FaxNumber: | 3343839541 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 N COLLEGE ST | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 360372025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3343822681 | ||||||||
| FaxNumber: | 3343839541 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2010 | ||||||||
| LastUpdateDate: | 10/19/2017 | ||||||||
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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 | 208D00000X | ME111635 | FL | N | Allopathic & Osteopathic Physicians | General Practice | 208D00000X | MD.30478 | AL | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 511-17014 | 01 | AL | BC/BS | OTHER | 128794 | 05 | AL | MEDICAID | 1871003533 | 01 | GROUP NPI | OTHER |