MEDICARE: DR. EMILY ELLIS 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	207Q00000X	Family Medicine Physician	060066	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	511I080124	OTHER	GA	MEDICARE

General Provider Information

NPI Number	:	1679597736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMILY ELLIS RICHARDSON M.D.

Provider Business Mailing Address
First Line	:	1230 JOHNSON FERRY PL
Second Line	:	SUITE A-10
City	:	MARIETTA
State	:	GA
Zip	:	30068-2048
Country	:	US
Telephone Number	:	678-560-0511
Fax Number	:	678-560-0739

Provider Business Practice Location Address
First Line	:	1230 JOHNSON FERRY PL
Second Line	:	SUITE A-10
City	:	MARIETTA
State	:	GA
Zip	:	30068-2048
Country	:	US
Telephone Number	:	678-560-0511
Fax Number	:	678-560-0739

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	03/07/2023

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Directions to “ DR. EMILY ELLIS RICHARDSON M.D.” Practice Location

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