MEDICARE: GERRY B RICHARDSON MSW

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	101YP1600X	Pastoral Counselor
2	104100000X	Social Worker

General Provider Information

NPI Number	:	1194533653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERRY B RICHARDSON MSW

Provider Business Mailing Address
First Line	:	7180 SPRINGCHASE WAY
Second Line	:
City	:	AUSTELL
State	:	GA
Zip	:	30168-6322
Country	:	US
Telephone Number	:	678-458-8296
Fax Number	:

Provider Business Practice Location Address
First Line	:	7180 SPRINGCHASE WAY
Second Line	:
City	:	AUSTELL
State	:	GA
Zip	:	30168-6322
Country	:	US
Telephone Number	:	678-458-8296
Fax Number	:

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

Provider Enumeration Date	:	12/30/2024
Last Update Date	:	12/30/2024

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