Provider Demographics
NPI:1881627545
Name:RICHARDSON, HUGH L (DPM)
Entity type:Individual
Prefix:
First Name:HUGH
Middle Name:L
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 CIRCLE 75 PKWY.
Mailing Address - Street 2:STE. 900
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3084
Mailing Address - Country:US
Mailing Address - Phone:770-384-0284
Mailing Address - Fax:404-446-1957
Practice Address - Street 1:5673 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:STE. 470
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1731
Practice Address - Country:US
Practice Address - Phone:404-237-3668
Practice Address - Fax:404-237-9562
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005570213E00000X
GAPOD001123213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I483179Medicare PIN
U87926Medicare UPIN