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NPI Code Detail

MEDICARE: TOMMIE MACK RICHARDSON MD

MEDICARE: TOMMIE MACK RICHARDSON MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor031313GA
2207QA0401XAddiction Medicine (Family Medicine) Physician31313GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1013006584
Entity Type Code : Individual
Provider Name (Legal Business Name) : TOMMIE MACK RICHARDSON MD
Provider Business Mailing Address
First Line : 4015 S COBB DR
Second Line : #115
City : SMYRNA
State : GA
Zip : 30080
Country : US
Telephone Number : 770-431-2354
Fax Number : 770-436-7143
Provider Business Practice Location Address
First Line : 400 TECHNOLOGY CT SE STE J
Second Line :
City : SMYRNA
State : GA
Zip : 30082-5237
Country : US
Telephone Number : 770-866-5700
Fax Number : 770-436-7143
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2006
Last Update Date : 12/07/2023

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Directions to “ TOMMIE MACK RICHARDSON MD” Practice Location

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