MEDICARE: JAMES DARRYL RICHARDS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD020946	TN
2	207Q00000X	Family Medicine Physician	MD20946	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831181205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES DARRYL RICHARDS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1130
Second Line	:
City	:	COOKEVILLE
State	:	TN
Zip	:	38503-1130
Country	:	US
Telephone Number	:	931-239-0284
Fax Number	:

Provider Business Practice Location Address
First Line	:	3830 MIRANDY RD
Second Line	:
City	:	COOKEVILLE
State	:	TN
Zip	:	38506-8646
Country	:	US
Telephone Number	:	931-239-0284
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	07/20/2011

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