Provider Demographics
NPI:1063258234
Name:RICHARDSON, MICHELLE NICOLE (BSN, RN)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:NICOLE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:NICOLE
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5802 JAMERSON DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-7017
Mailing Address - Country:US
Mailing Address - Phone:615-818-3501
Mailing Address - Fax:
Practice Address - Street 1:1253 CAROLINE ST NE STE 118
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-2759
Practice Address - Country:US
Practice Address - Phone:470-475-3445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA214624163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse