Basic Information
| Provider Information | |||||||||
| NPI: | 1023668894 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RICHMAN | ||||||||
| FirstName: | HUNTER | ||||||||
| MiddleName: | DENNARD | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1748 FLORIDA AVE | ||||||||
| Address2: | |||||||||
| City: | SOPERTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 304573431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4782990160 | ||||||||
| FaxNumber: | 9125355457 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 MEADOWS PKWY | ||||||||
| Address2: | |||||||||
| City: | VIDALIA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 304748759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9125355555 | ||||||||
| FaxNumber: | 9125355457 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2019 | ||||||||
| LastUpdateDate: | 09/17/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 9425 | GA | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.