Healthcare Provider Details

I. General information

NPI: 1881343465
Provider Name (Legal Business Name): MADISON ELYSE RICHARDS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 JOHN WESLEY GILBERT DRIVE
AUGUSTA GA
30912-0001
US

IV. Provider business mailing address

1430 JOHN WESLEY GILBERT DRIVE
AUGUSTA GA
30912-0001
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-2607
  • Fax:
Mailing address:
  • Phone: 706-721-2607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN123762
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code125Q00000X
TaxonomyOral Medicine Dentistry
License NumberDN123762
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: