Provider Demographics
NPI:1659533875
Name:RICHARDSON, CYNTHIA J (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:J
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:CINDY
Other - Middle Name:A
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:65 OLD JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-3095
Mailing Address - Country:US
Mailing Address - Phone:678-490-0080
Mailing Address - Fax:678-490-0091
Practice Address - Street 1:65 OLD JACKSON RD
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252-3095
Practice Address - Country:US
Practice Address - Phone:678-490-0080
Practice Address - Fax:678-490-0091
Is Sole Proprietor?:No
Enumeration Date:2008-06-29
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN083527163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA821621557FMedicaid
GA202I503666Medicare PIN