Healthcare Provider Details

I. General information

NPI: 1831341775
Provider Name (Legal Business Name): DR. CHRISTOPHER S RICHARDS MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2008
Last Update Date: 11/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 S DOOLY ST
MONTEZUMA GA
31063-1612
US

IV. Provider business mailing address

PO BOX 160
MONTEZUMA GA
31063-0160
US

V. Phone/Fax

Practice location:
  • Phone: 478-472-8672
  • Fax:
Mailing address:
  • Phone: 478-472-8672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number058316
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number113167
License Number StateGA

VIII. Authorized Official

Name: DR. CHRISTOPHER STERLING RICHARDS
Title or Position: OWNER/CEO
Credential: MD
Phone: 478-472-8672