Provider Demographics
NPI:1558589713
Name:RICHARDSON, JOHN TROY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:TROY
Last Name:RICHARDSON
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 1:860 PEACHTREE ST NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-1249
Mailing Address - Country:US
Mailing Address - Phone:917-701-5364
Mailing Address - Fax:
Practice Address - Street 1:1755 THE EXCHANGE SE STE 232
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-7432
Practice Address - Country:US
Practice Address - Phone:470-502-0099
Practice Address - Fax:470-502-0099
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0580992084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1558589713OtherADDICTION MEDICINE PRACTICE