MEDICARE: DR. JERRY MARK RICHMAN DDS

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	1223G0001X	General Practice Dentistry	8907	GA

General Provider Information

NPI Number	:	1144340431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERRY MARK RICHMAN DDS

Provider Business Mailing Address
First Line	:	4101 ORCHARD LAKE CT SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-4634
Country	:	US
Telephone Number	:	770-436-2848
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 NORTHSIDE PKWY NW BLDG 4-200
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-3063
Country	:	US
Telephone Number	:	404-841-9500
Fax Number	:	404-841-0405

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

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	07/08/2007

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