Provider Demographics
NPI:1134106495
Name:RICHARDS, CHARLES CHRISTOPHER (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:CHRISTOPHER
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1060 WINDY HILL RD SE STE 200
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-2065
Mailing Address - Country:US
Mailing Address - Phone:770-941-7709
Mailing Address - Fax:771-941-6441
Practice Address - Street 1:1060 WINDY HILL RD SE STE 200
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-2065
Practice Address - Country:US
Practice Address - Phone:770-941-7709
Practice Address - Fax:771-941-6441
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA52815208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics