Provider Demographics
NPI:1083712822
Name:RICHARDSON, WILLIAM E (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:E
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 COBB PKWY S
Mailing Address - Street 2:#191
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-6544
Mailing Address - Country:US
Mailing Address - Phone:770-419-4471
Mailing Address - Fax:770-419-4473
Practice Address - Street 1:950 COBB PKWY S
Practice Address - Street 2:#191
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-6544
Practice Address - Country:US
Practice Address - Phone:770-419-4471
Practice Address - Fax:770-419-4473
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA026631207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I084387Medicare UPIN
GA511I080120Medicare UPIN
GA511G700201Medicare PIN
GAC70354Medicare UPIN