Healthcare Provider Details

I. General information

NPI: 1184884702
Provider Name (Legal Business Name): CYNTHIA D RICHARDSON GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 12/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 N WASHINGTON ST
SUMTER SC
29150-4949
US

IV. Provider business mailing address

PO BOX 743904
ATLANTA GA
30374-3904
US

V. Phone/Fax

Practice location:
  • Phone: 803-774-1788
  • Fax: 803-774-9113
Mailing address:
  • Phone: 803-296-7320
  • Fax: 803-296-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3605
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number3605
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: