Healthcare Provider Details

I. General information

NPI: 1326276858
Provider Name (Legal Business Name): DR. TIMOTHY GERARD RICHARDSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: TIMOTHY GERARD RICHARDSON D.C.

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 07/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11348 TARA BLVD STE 100
HAMPTON GA
30228-6277
US

IV. Provider business mailing address

11348 TARA BLVD STE 100
HAMPTON GA
30228-6277
US

V. Phone/Fax

Practice location:
  • Phone: 404-606-0712
  • Fax:
Mailing address:
  • Phone: 404-606-0712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number008459
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number008459
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number008459
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number008459
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: