Healthcare Provider Details

I. General information

NPI: 1205482528
Provider Name (Legal Business Name): RICHARD ALEXANDER JABARDO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 08/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 GRASSLAND PKWY
ALPHARETTA GA
30004
US

IV. Provider business mailing address

1037 SUMMER PL NW
ACWORTH GA
30102-6307
US

V. Phone/Fax

Practice location:
  • Phone: 678-580-1404
  • Fax: 678-580-1298
Mailing address:
  • Phone: 770-517-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: