Healthcare Provider Details

I. General information

NPI: 1902291107
Provider Name (Legal Business Name): AARON COLE RICHARDSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2015
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 COLLIER RD NW STE 500
ATLANTA GA
30309-1711
US

IV. Provider business mailing address

653 W. 8TH ST, BOX L-18
JACKSONVILLE FL
32209-6511
US

V. Phone/Fax

Practice location:
  • Phone: 404-605-2800
  • Fax:
Mailing address:
  • Phone: 904-383-1003
  • Fax: 904-244-7388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number96277
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: