Provider Demographics
NPI:1679661359
Name:RICHARDSON, DAVID MORRIS (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MORRIS
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2955 HORIZON PARK DR STE B
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-7255
Mailing Address - Country:US
Mailing Address - Phone:770-904-3772
Mailing Address - Fax:770-904-3844
Practice Address - Street 1:2955 HORIZON PARK DR STE B
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-7255
Practice Address - Country:US
Practice Address - Phone:770-904-3772
Practice Address - Fax:770-904-3844
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA02231111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA55-0804991OtherTAX ID
GA55-0804991OtherTAX ID