Provider Demographics
NPI:1902806284
Name:RICHMAN, CRAIG ALAN (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:ALAN
Last Name:RICHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1474 VALLEY GLEN WAY
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-5522
Mailing Address - Country:US
Mailing Address - Phone:770-396-4668
Mailing Address - Fax:770-396-4668
Practice Address - Street 1:1474 VALLEY GLEN WAY
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-5522
Practice Address - Country:US
Practice Address - Phone:404-990-1899
Practice Address - Fax:770-396-4668
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048710174400000X
GA48710207YS0012X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
No207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH14081Medicare UPIN