Provider Demographics
NPI:1215994108
Name:RHODES, RICHARD D (DO)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:D
Last Name:RHODES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 HENDERSON ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2647
Mailing Address - Country:US
Mailing Address - Phone:803-758-2600
Mailing Address - Fax:
Practice Address - Street 1:8091 RIVERS AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9236
Practice Address - Country:US
Practice Address - Phone:843-572-7000
Practice Address - Fax:843-572-4070
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC347207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC003472Medicaid
SC003472Medicaid