MEDICARE: SAVANNAH RICHARDSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician	001016415	NC
2	363A00000X	Physician Assistant	0010-16415	NC

General Provider Information

NPI Number	:	1104780576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAVANNAH RICHARDSON

Provider Business Mailing Address
First Line	:	1248 HUFFMAN MILL RD STE 101
Second Line	:
City	:	BURLINGTON
State	:	NC
Zip	:	27215-8700
Country	:	US
Telephone Number	:	336-890-3390
Fax Number	:

Provider Business Practice Location Address
First Line	:	1248 HUFFMAN MILL RD STE 101
Second Line	:
City	:	BURLINGTON
State	:	NC
Zip	:	27215-8700
Country	:	US
Telephone Number	:	336-890-3390
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	05/22/2026

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Directions to “ SAVANNAH RICHARDSON ” Practice Location

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