Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 38595 | GA |
N | 208600000X | Surgeon | 38595 | GA |
N | 2086S0102X | Surgical Critical Care | 38595 | GA |
Y | 2086S0127X | Trauma Surgeon | 38595 | GA |
NPI | 1194764985 |
---|---|
Provider Name | Charles M Richart |
First Address | Atlanta, GA 30374-2616 |
Second Address | Gainesville, GA 30501-3715 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 07/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102515706 | (05) | TX |
102515707 | MEDICAID-CSHCN (01) | TX |
F46663 | (02) | MO |