Provider Demographics
NPI:1053971028
Name:MCNEELY, RICHARD RANDALL (DMD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:RANDALL
Last Name:MCNEELY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 DEER RUN TRCE
Mailing Address - Street 2:
Mailing Address - City:SWAINSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30401-4450
Mailing Address - Country:US
Mailing Address - Phone:478-494-9654
Mailing Address - Fax:
Practice Address - Street 1:1725 DAWSON RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-3362
Practice Address - Country:US
Practice Address - Phone:229-883-7891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0158851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice