Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 053023 | GA |
NPI | 1114924073 |
---|---|
Provider Name | Dr. Matthew M Richardson |
First Address | Atlanta, GA 30342-1703 |
Second Address | Atlanta, GA 30342-1703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H92218 | (02) |