Active NPI
Sam W Richwine Jr., M. D.
- Plastic Surgery Physician
- Gainesville, GA
National Provider Identifier
1386753564
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Plastic Surgery Physician
- License
- 019761
- Practice address
- 1296 Sims St
Suite B
Gainesville, GA 30501-3850 - Phone
- (770) 534-1856
- Fax
- (770) 531-0355
- NPI assigned
- Aug 30, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic Surgery Physician | 208200000X | 019761 | GA | Primary |
Addresses
Primary practice location
1296 Sims St
Suite B
Gainesville, GA 30501-3850
Mailing address
1296 Sims St
Suite B
Gainesville, GA 30501-3850
Phone (770) 534-1856
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00193498D | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019761 | GA | MD | Plastic Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1386753564",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1296 SIMS ST",
"address_2": "SUITE B",
"city": "GAINESVILLE",
"state": "GA",
"postal_code": "305013850",
"telephone_number": "770-534-1856",
"fax_number": "770-531-0355"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1296 SIMS ST",
"address_2": "SUITE B",
"city": "GAINESVILLE",
"state": "GA",
"postal_code": "305013850",
"telephone_number": "770-534-1856",
"fax_number": "770-531-0355"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RICHWINE",
"first_name": "SAM",
"middle_name": "W",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "M. D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208200000X",
"taxonomy_group": "",
"desc": "Plastic Surgery",
"state": "GA",
"license": "019761",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00193498D",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gainesville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.