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General NPI Number Information
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NPI Number | 1730856568
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Entity Type | Individual
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Provider Name | MONICA MEDEA RICHARDSON
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Gender | Female
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Dates
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Enumeration Date | 08/28/2021
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Last Update Date | 05/06/2022
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Provider Practice Location Address
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Address Line | 400 EMBASSY ROW STE 110
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City | ATLANTA
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State | GA
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Zip | 30328-5723
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Country | US
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Telephone | 770-394-7074
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Fax |
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Provider Business Mailing Address
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Address Line | 1036 WHITFIELD CT SE
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City | SMYRNA
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State | GA
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Zip | 30080-2241
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Country | US
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Telephone | 770-572-1612
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT003968
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License Number State | GA
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