Provider Demographics
NPI:1528679172
Name:RICHARDSON, RISHANA LATRICE
Entity type:Individual
Prefix:
First Name:RISHANA
Middle Name:LATRICE
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 1:1650 ANDERSON MILL RD APT 11103
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1295
Mailing Address - Country:US
Mailing Address - Phone:910-376-6674
Mailing Address - Fax:
Practice Address - Street 1:2450 ATLANTA HWY STE 904
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-1252
Practice Address - Country:US
Practice Address - Phone:404-659-5909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-16
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024179735363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGAA-NP000584OtherGEORGIA BOARD OF NURSING
VA002419735OtherVA BOARD OF NURSING