Provider Demographics
NPI:1629619895
Name:RICHARDS, CAROLINE B (NP-C)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:B
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:BONGI
Other - Last Name:NDLOVU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:223 JAMES P BRAWLEY DR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30314-4385
Mailing Address - Country:US
Mailing Address - Phone:404-880-6146
Mailing Address - Fax:404-880-6010
Practice Address - Street 1:223 JAMES P BRAWLEY DR SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30314-4385
Practice Address - Country:US
Practice Address - Phone:404-880-6146
Practice Address - Fax:404-880-6010
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAR070440363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily