| Provider / Organization | NPI | Date Certified |
|---|---|---|
| MARY LEE RICHARDSON | 1407455959 | 2020-10-25 |
Mary Lee Richardson is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1407455959. Registration indicates Mary Lee Richardson is a provider of services with a specialization in Respiratory, Developmental, Rehabilitative and Restorative Service Providers, Specialist/Technologist (Specialist/Technologist: Athletic Trainer, ) (All Other Specialties & Provider Types, ) (Specialist/Technologist Athletic Trainer, Respiratory, Developmental, Rehabilitative and Restorative Service Providers) (Specialist/Technologist, )
| Entity Type | Individual |
| Provider Name | Mary Lee Richardson |
| Practice Office Address | 1591 GLENN PL SW MABLETON, GA US |
| Practice Office Telephone | 2167027316 |
| Mailing Address | 1591 GLENN PL SW MABLETON, GA 301261170 US |
| Business Telephone | 2167027316 |
| Code | Practice | License No State |
|---|---|---|
| 2255A2300X PRIMARY | Respiratory, Developmental, Rehabilitative and Restorative Service Providers Specialist/Technologist Specialist/Technologist: Athletic Trainer All Other Specialties & Provider Types Specialist/Technologist Athletic Trainer Respiratory, Developmental, Rehabilitative and Restorative Service Providers Specialist/Technologist |
GA |