Basic Information
| Provider Information | |||||||||
| NPI: | 1003011578 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RICHARDSON | ||||||||
| FirstName: | GAA | ||||||||
| MiddleName: | ODETTA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 415 N CENTER ST | ||||||||
| Address2: | STE. 300 | ||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286015057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283283300 | ||||||||
| FaxNumber: | 8283289101 | ||||||||
| Practice Location | |||||||||
| Address1: | 415 N CENTER ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286015057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283283300 | ||||||||
| FaxNumber: | 8283289101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2007 | ||||||||
| LastUpdateDate: | 07/27/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 2004024412 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | 2008-00566 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.