Healthcare Provider Details

I. General information

NPI: 1730238254
Provider Name (Legal Business Name): ELLEN HARRIS RICHARDSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 BRYAN WOODS ROAD ELLEN RICHARDSON MD
SAVANNAH GA
31410-1225
US

IV. Provider business mailing address

102 BRYAN WOODS ROAD ELLEN RICHARDSON MD
SAVANNAH GA
31410-1225
US

V. Phone/Fax

Practice location:
  • Phone: 912-898-1122
  • Fax: 912-898-9944
Mailing address:
  • Phone: 912-898-1122
  • Fax: 912-898-9944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number40528
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: