Glass, Richard

Glass, Richard is an sole proprietor health care provider with primary practice located at 20 Herrell Rd , Villa Rica GA 30180-5527. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Glass, Richard can be contacted via phone (770) 456-3929.

Contact Information

Primary practice address
20 Herrell Rd Villa Rica GA 30180-5527
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 250913 New York
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 062989 Georgia

Profile Details

NPI number 1780820753
LBN Legal business name Glass, Richard
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 22nd, 2008
Last updated Oct 11th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1780820753 NPPES
Georgia MEDICAID 344112558A

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