Provider Demographics
NPI:1083448138
Name:RICHMOND, GREGORY K
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:K
Last Name:RICHMOND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 PLANTATION RD
Mailing Address - Street 2:
Mailing Address - City:TALCOTT
Mailing Address - State:WV
Mailing Address - Zip Code:24981-7071
Mailing Address - Country:US
Mailing Address - Phone:704-408-9817
Mailing Address - Fax:
Practice Address - Street 1:141 PLANTATION RD
Practice Address - Street 2:
Practice Address - City:TALCOTT
Practice Address - State:WV
Practice Address - Zip Code:24981-7071
Practice Address - Country:US
Practice Address - Phone:704-408-9817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant