Provider Demographics
NPI:1609040328
Name:ABBOTT, RICHARD S (LAC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:S
Last Name:ABBOTT
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 SUN VALLEY DR STE H1
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-5627
Mailing Address - Country:US
Mailing Address - Phone:678-277-2790
Mailing Address - Fax:
Practice Address - Street 1:555 SUN VALLEY DR STE H1
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5627
Practice Address - Country:US
Practice Address - Phone:678-277-2790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA199171100000X
FLAP2188171100000X
GA171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist