Healthcare Provider Details

I. General information

NPI: 1770828691
Provider Name (Legal Business Name): JOSEPH RIORDAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2012
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 SPRINGDALE RD SW
ATLANTA GA
30315-7802
US

IV. Provider business mailing address

2850 SPRINGDALE RD SW
ATLANTA GA
30315-7802
US

V. Phone/Fax

Practice location:
  • Phone: 404-762-8672
  • Fax: 404-768-8630
Mailing address:
  • Phone: 404-762-8672
  • Fax: 404-768-8630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA000990
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: