MEDICARE: RICHARD A OFFUTT PSYD

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	103T00000X	Psychologist	001343	GA

General Provider Information

NPI Number	:	1265521736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD A OFFUTT PSYD

Provider Business Mailing Address
First Line	:	4015 SOUTH COBB DR
Second Line	:	#115
City	:	SMYRNA
State	:	GA
Zip	:	30080
Country	:	US
Telephone Number	:	770-431-2354
Fax Number	:	770-436-7143

Provider Business Practice Location Address
First Line	:	4015 SOUTH COBB DR
Second Line	:	#115
City	:	SMYRNA
State	:	GA
Zip	:	30080
Country	:	US
Telephone Number	:	770-431-2354
Fax Number	:	770-436-7143

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	01/18/2026

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Directions to “ RICHARD A OFFUTT PSYD” Practice Location

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