Provider Demographics
NPI:1841893823
Name:RICHARDSON, COURTNEY NICOLE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:NICOLE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MRS
Other - First Name:COURTNEY
Other - Middle Name:NICOLE
Other - Last Name:KONWICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6945 NASHVILLE ST
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-2419
Mailing Address - Country:US
Mailing Address - Phone:706-935-9861
Mailing Address - Fax:706-935-3252
Practice Address - Street 1:6945 NASHVILLE ST
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-2419
Practice Address - Country:US
Practice Address - Phone:706-935-9861
Practice Address - Fax:706-935-3252
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38174183500000X
GARPH028112183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist