Provider Demographics
NPI:1285749747
Name:GROVES, E RICHARD (DPM)
Entity type:Individual
Prefix:
First Name:E
Middle Name:RICHARD
Last Name:GROVES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 GORDON AVE
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-6611
Mailing Address - Country:US
Mailing Address - Phone:229-226-1338
Mailing Address - Fax:229-226-4888
Practice Address - Street 1:800 GORDON AVE
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6611
Practice Address - Country:US
Practice Address - Phone:229-226-1338
Practice Address - Fax:229-226-4888
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000551213ES0103X
FLPO1679213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA480028811OtherRAILROAD MEDICARE
GA000368013AMedicaid
GA0509810001OtherMEDICARE NSC
GA480028811OtherRAILROAD MEDICARE
GA$$$$$$$$$AMedicare PIN