Provider Demographics
NPI:1760401756
Name:RICHARDS, KIMBERLYNN R (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLYNN
Middle Name:R
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1865 LYON AVE SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-8450
Mailing Address - Country:US
Mailing Address - Phone:404-272-1724
Mailing Address - Fax:404-344-6155
Practice Address - Street 1:3634 HIGHLANDS PKWY SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-5184
Practice Address - Country:US
Practice Address - Phone:770-801-0980
Practice Address - Fax:770-801-9039
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA038930207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF60764Medicare UPIN
MD11BDMCSMedicare ID - Type Unspecified
GA202I116033Medicare PIN