Edwin M Richardson, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

10241 Issued in GA

Practice address

113 Ebenezer Rd
Suite 101
Fayetteville, GA 30215-4816

Phone

(770) 487-9797

NPI assigned

Mar 6, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1831229426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 EBENEZER RD",
            "address_2": "SUITE 101",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302154816",
            "telephone_number": "770-487-9797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 EBENEZER RD",
            "address_2": "SUITE 101",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302154816",
            "telephone_number": "770-487-9797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "EDWIN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "10241",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "T.I.N",
            "identifier": "58-1433916",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Fayetteville, GA
• Providers in Fayetteville, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.