Healthcare Provider Details

I. General information

NPI: 1164475893
Provider Name (Legal Business Name): CHRISTOPHER RICHARDS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 POPLAR ST
IDEAL GA
31041-6264
US

IV. Provider business mailing address

201 POPLAR ST
IDEAL GA
31041-6264
US

V. Phone/Fax

Practice location:
  • Phone: 478-244-2866
  • Fax: 404-478-8420
Mailing address:
  • Phone: 478-244-2866
  • Fax: 404-478-8420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01057372
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number058316
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: