Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 037827 | GA |
NPI | 1093758104 |
---|---|
Provider Name | Dr. Richard L Harvey |
First Address | Lawrenceville, GA 30046-3367 |
Second Address | Lawrenceville, GA 30046-3367 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 16/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00588123E | (05) | GA |
52478219 | BLUE CROSS (01) | GA |
770002651 | RAIL ROAD (01) | GA |
F76049 | (02) | GA |