Provider Demographics
NPI:1750701850
Name:RICHARDS, SYRANA
Entity type:Individual
Prefix:MR
First Name:SYRANA
Middle Name:
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 EVEREE INN RD
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4714
Mailing Address - Country:US
Mailing Address - Phone:678-603-1484
Mailing Address - Fax:
Practice Address - Street 1:816 EVEREE INN RD
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4714
Practice Address - Country:US
Practice Address - Phone:678-603-1484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-16
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1962822817OtherMEDICARE
GA46-5422576OtherFEDERAL EIN