Provider Demographics
NPI:1164475893
Name:RICHARDS, CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:RICHARDS
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 1:201 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:IDEAL
Mailing Address - State:GA
Mailing Address - Zip Code:31041-6264
Mailing Address - Country:US
Mailing Address - Phone:478-244-2866
Mailing Address - Fax:404-478-8420
Practice Address - Street 1:201 POPLAR ST
Practice Address - Street 2:
Practice Address - City:IDEAL
Practice Address - State:GA
Practice Address - Zip Code:31041-6264
Practice Address - Country:US
Practice Address - Phone:478-244-2866
Practice Address - Fax:404-478-8420
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057372207Q00000X
GA058316207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA123048280FMedicaid
GA123048280AMedicaid
GAH93049Medicare UPIN
08CBBWHMedicare PIN