=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235107772
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EDDIE RICHARDSON MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2006
-----------------------------------------------------
Last Update Date | 10/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 114 HARMONY XING STE 1
-----------------------------------------------------
City | EATONTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31024-9546
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-484-0884
-----------------------------------------------------
Fax | 706-484-0885
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 114 HARMONY XING STE 1
-----------------------------------------------------
City | EATONTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31024-9546
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-484-0884
-----------------------------------------------------
Fax | 706-484-0885
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | 24642
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207QA0505X
-----------------------------------------------------
Taxonomy Name | Adult Medicine Physician
-----------------------------------------------------
License Number | 052047
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 052047
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------