Healthcare Provider Details

I. General information

NPI: 1134112915
Provider Name (Legal Business Name): JOHN D RICHMOND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 N THORNTON AVE STE 107
DALTON GA
30720-8394
US

IV. Provider business mailing address

1506 BROADRICK DR
DALTON GA
30720-3011
US

V. Phone/Fax

Practice location:
  • Phone: 706-278-0138
  • Fax:
Mailing address:
  • Phone: 706-278-3430
  • Fax: 706-279-1327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number26018
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: