Provider Demographics
NPI:1447303144
Name:DOVER, RICHARD K (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:K
Last Name:DOVER
Suffix:
Gender:M
Credentials:MD
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 15324
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30919-1324
Mailing Address - Country:US
Mailing Address - Phone:706-731-5831
Mailing Address - Fax:
Practice Address - Street 1:3540 WHEELER RD
Practice Address - Street 2:SUITE 617
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-1871
Practice Address - Country:US
Practice Address - Phone:706-731-5831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA030050207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA329184788AMedicaid
GA002628OtherBCBS OF GEORGIA
GA10040080OtherAMERIGROUP
GA52497628OtherBCBS
GA002628OtherBCBS OF GEORGIA
GA52497628OtherBCBS