Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | 0101242855 | VA |
Y | 2084N0400X | Neurologist | 24287 | WV |
NPI | 1043489776 |
---|---|
Provider Name | Georgianna M Richards |
First Address | Beckley, WV 25801-2805 |
Second Address | Beckley, WV 25801-2805 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2008 |
Last Update Date | 02/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1043489776 | (05) | VA |
1720314677 | GROUP NPI (01) | VA |