Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NI0013X | Independent Medical Examiner | 008459 | GA |
N | 111NN0400X | Neurology | 008459 | GA |
N | 111NS0005X | Chiropractic Sports Physician | 008459 | GA |
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 008459 | GA |
NPI | 1326276858 |
---|---|
Provider Name | Dr. Timothy Gerard Richardson |
First Address | Hampton, GA 30228-6277 |
Second Address | Hampton, GA 30228-6277 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2009 |
Last Update Date | 20/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
008459 | (05) | GA |