Provider Demographics
NPI:1194549659
Name:RICHARDSON, AYINA
Entity type:Individual
Prefix:
First Name:AYINA
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:681 HINSON AVE
Mailing Address - Street 2:
Mailing Address - City:PRICHARD
Mailing Address - State:AL
Mailing Address - Zip Code:36610-2714
Mailing Address - Country:US
Mailing Address - Phone:251-509-9522
Mailing Address - Fax:
Practice Address - Street 1:681 HINSON AVE
Practice Address - Street 2:
Practice Address - City:PRICHARD
Practice Address - State:AL
Practice Address - Zip Code:36610-2714
Practice Address - Country:US
Practice Address - Phone:251-509-9522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program