Provider Demographics
NPI:1932896511
Name:RICHARDSON, CHARLESHA
Entity Type:Individual
Prefix:MS
First Name:CHARLESHA
Middle Name:
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 1:8595 PELHAM RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-5759
Mailing Address - Country:US
Mailing Address - Phone:864-621-5601
Mailing Address - Fax:864-773-3120
Practice Address - Street 1:8595 PELHAM RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-5759
Practice Address - Country:US
Practice Address - Phone:864-621-5601
Practice Address - Fax:864-773-3120
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCK9J6S4R7202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology