MEDICARE: DR. CHARLES CHRISTOPHER RICHARDS M.D.

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
1	208000000X	Pediatrics Physician	52815	GA

General Provider Information

NPI Number	:	1134106495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES CHRISTOPHER RICHARDS M.D.

Provider Business Mailing Address
First Line	:	1060 WINDY HILL RD SE STE 200
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-2065
Country	:	US
Telephone Number	:	770-941-7709
Fax Number	:	771-941-6441

Provider Business Practice Location Address
First Line	:	1060 WINDY HILL RD SE STE 200
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-2065
Country	:	US
Telephone Number	:	770-941-7709
Fax Number	:	771-941-6441

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	07/09/2018

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