Individual
MR. SYRANA RICHARDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
816 EVEREE INN RD, GRIFFIN, GA 30224-4714
(678) 603-1484
Mailing address
816 EVEREE INN RD, GRIFFIN, GA 30224-4714
(678) 603-1484
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1962822817
MEDICARE
GA
Enumeration date
04/16/2014
Last updated
06/23/2014
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