Provider Demographics
NPI:1194533653
Name:RICHARDSON, GERRY B (MSW)
Entity type:Individual
Prefix:
First Name:GERRY
Middle Name:B
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7180 SPRINGCHASE WAY
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30168-6322
Mailing Address - Country:US
Mailing Address - Phone:678-458-8296
Mailing Address - Fax:
Practice Address - Street 1:7180 SPRINGCHASE WAY
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30168-6322
Practice Address - Country:US
Practice Address - Phone:678-458-8296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral