Healthcare Provider Details

I. General information

NPI: 1942833348
Provider Name (Legal Business Name): MARJORIE RICHARD MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2020
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5067 FIELDGREEN XING
STONE MOUNTAIN GA
30088-3102
US

IV. Provider business mailing address

5067 FIELDGREEN XING
STONE MOUNTAIN GA
30088-3102
US

V. Phone/Fax

Practice location:
  • Phone: 954-470-9035
  • Fax: 470-357-6577
Mailing address:
  • Phone: 954-470-9035
  • Fax: 470-357-6577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN-NP264132
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: