Provider Demographics
NPI:1932261773
Name:RICHARDS, ANGELA L (DC)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:L
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 HEAD AVE
Mailing Address - Street 2:
Mailing Address - City:TALLAPOOSA
Mailing Address - State:GA
Mailing Address - Zip Code:30176-1260
Mailing Address - Country:US
Mailing Address - Phone:770-574-5005
Mailing Address - Fax:770-574-5006
Practice Address - Street 1:145 HEAD AVE
Practice Address - Street 2:
Practice Address - City:TALLAPOOSA
Practice Address - State:GA
Practice Address - Zip Code:30176-1260
Practice Address - Country:US
Practice Address - Phone:770-574-5005
Practice Address - Fax:770-574-5006
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007205111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU90226Medicare UPIN
GA35ZCHJZMedicare ID - Type UnspecifiedPROVIDER ID