Provider Demographics
NPI:1487127130
Name:RICHARDSON, NICHOLE F (OWNER)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:F
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 390551
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-0010
Mailing Address - Country:US
Mailing Address - Phone:678-448-2853
Mailing Address - Fax:770-676-7087
Practice Address - Street 1:3-4 ESTATE THOMAS, 3-4 ESTATE
Practice Address - Street 2:4TH STREET SUGAR ESTATE 4TH S
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-0080
Practice Address - Country:US
Practice Address - Phone:470-226-1766
Practice Address - Fax:470-226-1636
Is Sole Proprietor?:No
Enumeration Date:2019-01-05
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker