Provider Demographics
NPI:1407824865
Name:RICHARDSON, DEBORAH KAY (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:KAY
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 N SHADELAND AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-1706
Mailing Address - Country:US
Mailing Address - Phone:317-275-8072
Mailing Address - Fax:317-275-8018
Practice Address - Street 1:3651 WHEELER RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6521
Practice Address - Country:US
Practice Address - Phone:706-651-6544
Practice Address - Fax:706-651-6158
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA25025207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52235752OtherBCBS
GA345836OtherWELLCARE
GA0004281068Medicaid
SCG25025Medicaid
GA52235752OtherBCBS
22BDDTPMedicare PIN