1316277858 NPI number — KIMBERLYNN R. RICHARDS, MD, PC

Table of content: (NPI 1316277858)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316277858 NPI number — KIMBERLYNN R. RICHARDS, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIMBERLYNN R. RICHARDS, MD, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316277858
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1865 LYON AVE SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30331-8450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-272-1742
Provider Business Mailing Address Fax Number:
404-344-6155

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4015 S COBB DR SE
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
SMYRNA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30080-6303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-801-0980
Provider Business Practice Location Address Fax Number:
770-801-9039
Provider Enumeration Date:
01/06/2010

Additional Information

Authorized Official

Authorized Official Last Name:
RICHARDS
Authorized Official First Name:
KIMBERLYNN
Authorized Official Middle Name:
ROCHELLE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
404-272-1724

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  038930 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000625567J , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10171962 . This is a "BIRTHDAY" identifier . This identifiers is of the category "OTHER".




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