Individual
DR. EDWIN M RICHARDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
113 EBENEZER RD, SUITE 101, FAYETTEVILLE, GA 30215-4816
(770) 487-9797
Mailing address
113 EBENEZER RD, SUITE 101, FAYETTEVILLE, GA 30215-4816
(770) 487-9797
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10241
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
58-1433916
T.I.N
GA
Enumeration date
03/06/2007
Last updated
07/08/2007
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