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General NPI Number Information
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NPI Number | 1295552396
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Entity Type | Individual
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Provider Name | JONATHAN RICHARD MD
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Gender | Male
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Dates
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Enumeration Date | 09/21/2024
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 3200 DOWNWOOD CIR NW STE 640-4
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City | ATLANTA
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State | GA
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Zip | 30327-1610
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Country | US
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Telephone | 404-778-7290
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Fax |
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Provider Business Mailing Address
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Address Line | 141 NATCHEZ TRACE DR
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City | HARVEY
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State | LA
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Zip | 70058-6139
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Country | US
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Telephone | 985-227-1449
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 17607
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License Number State | GA
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