| Richard Glen Stiles, MD | |
|
1412 Milstead Ave Ne, Conyers, GA 30012-3877 | |
| (770) 918-3000 | |
| (678) 905-7053 |
| Full Name | Richard Glen Stiles |
|---|---|
| Gender | Male |
| Speciality | Radiology - Diagnostic Radiology |
| Location | 1412 Milstead Ave Ne, Conyers, Georgia |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700864972 | NPI | - | NPPES |
| 000282444E | Medicaid | GA | |
| 000282444I | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2085R0202X | Radiology - Diagnostic Radiology | 019834 (Tennessee) | Secondary |
| 2085R0202X | Radiology - Diagnostic Radiology | 25675 (Georgia) | Primary |
| Entity Name | Diagnostic Imaging Specialists Pa |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1366424947 PECOS PAC ID: 8123012366 Enrollment ID: O20040412000946 |
| Mailing Address | Practice Location Address |
|---|---|
| Richard Glen Stiles, MD Po Box 200096, Cartersville, GA 30120-9002 Ph: (678) 905-7053 | Richard Glen Stiles, MD 1412 Milstead Ave Ne, Conyers, GA 30012-3877 Ph: (770) 918-3000 |
Dr. Clifford N Grossman, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 1412 Milstead Ave Ne, Conyers, GA 30012 Phone: 770-918-3000 | |
Michelle A Ross, M.D. Radiology Medicare: Accepting Medicare Assignments Practice Location: 1412 Milstead Ave Ne, Conyers, GA 30012 Phone: 770-918-3000 | |
Dr. Bradley Lloyd Fricke, M.D. Radiology Medicare: Accepting Medicare Assignments Practice Location: 1412 Milstead Ave Ne, Conyers, GA 30012 Phone: 770-607-7339 Fax: 770-607-0789 | |
Suzanne Patrice Smith, MD Radiology Medicare: Medicare Enrolled Practice Location: 1293 Wellbrook Cir Ne, Conyers, GA 30012 Phone: 770-922-2012 Fax: 770-922-8370 | |
Dr. Ratna Sajja, MD Radiology Medicare: May Accept Medicare Assignments Practice Location: 1293 Wellbrook Cir Ne, Conyers, GA 30012 Phone: 770-922-2012 Fax: 770-922-8370 | |
Mark Otto Bernardy, MD Radiology Medicare: Not Enrolled in Medicare Practice Location: 1031 Jimson Dr Se, Conyers, GA 30013 Phone: 800-879-6274 Fax: 678-342-2547 |