Healthcare Provider Details

I. General information

NPI: 1750591004
Provider Name (Legal Business Name): HEATHER RENE RICHARDSON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 EPSON PLANTATION DR STE B
MONCKS CORNER SC
29461-3979
US

IV. Provider business mailing address

5000 EPSON PLANTATION DR STE B
MONCKS CORNER SC
29461-3979
US

V. Phone/Fax

Practice location:
  • Phone: 843-876-2951
  • Fax: 843-663-8166
Mailing address:
  • Phone: 843-876-2951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number83408
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: