Provider Demographics
NPI:1699718411
Name:CHASE, RICHARD K (DO)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:K
Last Name:CHASE
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:PO BOX 801
Mailing Address - Street 2:
Mailing Address - City:OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:31068-0801
Mailing Address - Country:US
Mailing Address - Phone:478-472-6713
Mailing Address - Fax:478-472-5142
Practice Address - Street 1:300 MEDICAL COURT
Practice Address - Street 2:
Practice Address - City:OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:31068-3706
Practice Address - Country:US
Practice Address - Phone:478-472-8178
Practice Address - Fax:478-472-3289
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA017784207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000113847GMedicaid
GA08LCCJRMedicare ID - Type Unspecified
GAE53950Medicare UPIN