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General NPI Number Information
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NPI Number | 1952539058
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Entity Type | Organization
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Legal Business Name | METROMED,LLC
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Dates
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Enumeration Date | 06/26/2009
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Last Update Date | 07/21/2009
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Provider Practice Location Address
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Address Line | 11348 TARA BLVE. STE.100
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City | LOVEJOY
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State | GA
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Zip | 30228-3558
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Country | US
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Telephone | 404-606-0712
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Fax |
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Provider Business Mailing Address
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Address Line | 11348 TARA BLVD STE 100
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City | HAMPTON
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State | GA
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Zip | 30228-6277
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Country | US
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Telephone | 404-933-5894
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL PHYSICIAN
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Name | DR. TIMOTHY GERARD RICHARDSON
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Credential | D.C.
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Telephone | 404-606-0712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 008459
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 008459
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | 008459
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License Number State | GA
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