Provider Demographics
NPI:1053538777
Name:DAVID M. RICHARDSON P.C.
Entity type:Organization
Organization Name:DAVID M. RICHARDSON P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MORRIS
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-904-3772
Mailing Address - Street 1:2955 HORIZON PARK DR STE B
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-7255
Mailing Address - Country:US
Mailing Address - Phone:770-904-3772
Mailing Address - Fax:770-904-3844
Practice Address - Street 1:2955 HORIZON PARK DR STE B
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-7255
Practice Address - Country:US
Practice Address - Phone:770-904-3772
Practice Address - Fax:770-904-3844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR002231111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU02046Medicare UPIN
GAGRP6726Medicare PIN