Provider Demographics
NPI:1932468709
Name:RICHARDSON, NICHOLAS SCOTT (MD)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:SCOTT
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3231 GLYNN AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520
Mailing Address - Country:US
Mailing Address - Phone:912-265-9006
Mailing Address - Fax:912-554-3636
Practice Address - Street 1:3231 GLYNN AVENUE
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520
Practice Address - Country:US
Practice Address - Phone:912-265-9006
Practice Address - Fax:912-554-3636
Is Sole Proprietor?:No
Enumeration Date:2012-05-14
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA79907207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery