Individual
MRS. JENNIFER RICHARDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ECSE
Contact information
Practice address
7950 MARTIN LOOP, FORT BENNING, GA 31905-5647
(706) 545-9116
(706) 545-5572
Mailing address
7950 MARTIN LOOP, FORT BENNING, GA 31905-5647
(706) 545-9116
(706) 545-5572
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
655026
GA
Other
Enumeration date
09/27/2006
Last updated
07/09/2007
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