Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RG0100X | Gastroenterologist | 2004024412 | MO |
Y | 207RG0100X | Gastroenterologist | 2008-00566 | NC |
NPI | 1003011578 |
---|---|
Provider Name | Dr. Gaa Odetta Richardson |
First Address | Hickory, NC 28601-5057 |
Second Address | Hickory, NC 28601-5057 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2007 |
Last Update Date | 27/07/2010 |