Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 11236 | GA |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 11236 | GA |
NPI | 1134125248 |
---|---|
Provider Name | Dr. Richard Eric Paul |
First Address | Mcdonough, GA 30253-4214 |
Second Address | Mcdonough, GA 30253-4214 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2005 |
Last Update Date | 30/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
19NCBRP | (02) | GA |
56761 | (02) | GA |