Provider Demographics
NPI:1275584542
Name:RICHMOND, CHERYL HERMIONE (MD)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:HERMIONE
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3495 PIEDMONT ROAD, NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305
Mailing Address - Country:US
Mailing Address - Phone:404-364-7070
Mailing Address - Fax:770-909-8005
Practice Address - Street 1:1478 DOGWOOD DRIVE, STE. B & C
Practice Address - Street 2:KAISER PERMANENTE MEDICAL OFFICE
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013
Practice Address - Country:US
Practice Address - Phone:770-909-8007
Practice Address - Fax:770-909-8005
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033255208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G01232Medicare UPIN