Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 047640 | GA |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 047640 | GA |
NPI | 1730181777 |
---|---|
Provider Name | Richard Howard Pike |
First Address | Atlanta, GA 30305 |
Second Address | Jonesboro, GA 30236 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 14/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000924382B | (05) | GA |
0486290001 | DME (01) | |
F73121 | (02) |