Provider Demographics
NPI:1366832552
Name:RICHARDSON, BARBARA (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 WOODACRES RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-1645
Mailing Address - Country:US
Mailing Address - Phone:404-376-1496
Mailing Address - Fax:
Practice Address - Street 1:2600 WOODACRES RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-1645
Practice Address - Country:US
Practice Address - Phone:404-376-1496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD004323133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered