Basic Information
| Provider Information | |||||||||
| NPI: | 1528679172 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RICHARDSON | ||||||||
| FirstName: | RISHANA | ||||||||
| MiddleName: | LATRICE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1650 ANDERSON MILL RD APT 11103 | ||||||||
| Address2: | |||||||||
| City: | AUSTELL | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301061295 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103766674 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2450 ATLANTA HWY STE 904 | ||||||||
| Address2: | |||||||||
| City: | CUMMING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300401252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4046595909 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2020 | ||||||||
| LastUpdateDate: | 01/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 0024179735 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | GAA-NP000584 | 01 | GA | GEORGIA BOARD OF NURSING | OTHER | 002419735 | 01 | VA | VA BOARD OF NURSING | OTHER |