Healthcare Provider Details

I. General information

NPI: 1235107772
Provider Name (Legal Business Name): EDDIE RICHARDSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 HARMONY XING STE 1
EATONTON GA
31024-9546
US

IV. Provider business mailing address

114 HARMONY XING STE 1
EATONTON GA
31024-9546
US

V. Phone/Fax

Practice location:
  • Phone: 706-484-0884
  • Fax: 706-484-0885
Mailing address:
  • Phone: 706-484-0884
  • Fax: 706-484-0885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number24642
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number052047
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number052047
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: