Healthcare Provider Details

I. General information

NPI: 1588709471
Provider Name (Legal Business Name): ERIC JOSEPH RICHARDS D.C.,MS EXERCISE PHY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 09/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8256 MAIN ST
WOODSTOCK GA
30188-5047
US

IV. Provider business mailing address

8256 MAIN ST
WOODSTOCK GA
30188-5047
US

V. Phone/Fax

Practice location:
  • Phone: 770-517-2240
  • Fax: 770-517-2286
Mailing address:
  • Phone: 770-517-2240
  • Fax: 770-517-2286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number006932
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: