Healthcare Provider Details

I. General information

NPI: 1578599361
Provider Name (Legal Business Name): CHESLEY LUCAS RICHARDS JR. MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 CLAIRMONT ROAD GRECC (11B) /ATLANTA VA MEDICAL CENTER
ATLANTA GA
30329
US

IV. Provider business mailing address

214 CALIBRE WOODS DR NE
ATLANTA GA
30329-3934
US

V. Phone/Fax

Practice location:
  • Phone: 404-321-6111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number033439
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: