Healthcare Provider Details

I. General information

NPI: 1639583776
Provider Name (Legal Business Name): ANNA LOUISE RICHARDSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3780 OLD NORCROSS RD SUITE 108
DULUTH GA
30096-1740
US

IV. Provider business mailing address

114 TOWNPARK DR NW STE 240
KENNESAW GA
30144-5802
US

V. Phone/Fax

Practice location:
  • Phone: 404-855-2244
  • Fax: 404-793-6105
Mailing address:
  • Phone: 770-485-3723
  • Fax: 678-803-6944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN240818
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: