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General NPI Number Information
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NPI Number | 1982741542
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Entity Type | Individual
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Provider Name | TAMARA CHANETTE RICHARDSON PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 03/02/2026
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Provider Practice Location Address
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Address Line | 610 19TH ST
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City | COLUMBUS
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State | GA
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Zip | 31901-1528
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Country | US
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Telephone | 706-322-7884
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Fax | 706-780-6075
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Provider Business Mailing Address
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Address Line | 2675 WINKLER AVE STE 200
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City | FORT MYERS
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State | FL
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Zip | 33901-9328
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Country | US
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Telephone | 877-856-3774
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | APA1596
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5806
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License Number State | GA
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