Basic Information
| Provider Information | |||||||||
| NPI: | 1184696817 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RISCHAR | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5007 | ||||||||
| Address2: | |||||||||
| City: | CORDELE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2292714656 | ||||||||
| FaxNumber: | 2292763633 | ||||||||
| Practice Location | |||||||||
| Address1: | 408 E 3RD AVE | ||||||||
| Address2: | |||||||||
| City: | CORDELE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2292712229 | ||||||||
| FaxNumber: | 2292763633 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2006 | ||||||||
| LastUpdateDate: | 01/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 041962 | GA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 00715327A | 05 | GA | MEDICAID |