Healthcare Provider Details

I. General information

NPI: 1659533875
Provider Name (Legal Business Name): CYNTHIA J RICHARDSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CINDY A JONES RN

II. Dates (important events)

Enumeration Date: 06/29/2008
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 W 3RD ST STE A
JACKSON GA
30233-1979
US

IV. Provider business mailing address

3333 RIVERWOOD PKWY SE STE 250
ATLANTA GA
30339-3304
US

V. Phone/Fax

Practice location:
  • Phone: 678-774-0430
  • Fax: 770-775-3410
Mailing address:
  • Phone: 770-914-0116
  • Fax: 770-955-4278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN083527
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: