MEDICARE: DR. DEREK KEITH RICHARDSON M.D.

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	2084P0804X	Child & Adolescent Psychiatry Physician	054273	GA

General Provider Information

NPI Number	:	1245247006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEREK KEITH RICHARDSON M.D.

Provider Business Mailing Address
First Line	:	3495 PIEDMONT RD NE
Second Line	:	NINE PIEDMONT CENTER
City	:	ATLANTA
State	:	GA
Zip	:	30305-1717
Country	:	US
Telephone Number	:	404-364-7070
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 CRESCENT CENTER PKWY
Second Line	:	KAISER PERMANENTE CRESCENT CENTRE MEDICAL CENTER
City	:	TUCKER
State	:	GA
Zip	:	30084-7047
Country	:	US
Telephone Number	:	770-496-3609
Fax Number	:

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

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	01/07/2022

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