Provider Demographics
NPI:1013791953
Name:RICHARDSON, ERICA TAYLOR
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:TAYLOR
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 421718
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29442-4203
Mailing Address - Country:US
Mailing Address - Phone:843-527-7000
Mailing Address - Fax:
Practice Address - Street 1:4017 HIGHWAY 17 STE 100
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-5032
Practice Address - Country:US
Practice Address - Phone:843-651-6525
Practice Address - Fax:843-357-0768
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-22
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29232367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife