Healthcare Provider Details

I. General information

NPI: 1093815722
Provider Name (Legal Business Name): CONNIE WALKER RICHARDSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 PIERSON AVE
CENTREVILLE AL
35042-2918
US

IV. Provider business mailing address

208 PIERSON AVENUE BIBB MEDICAL CENTER
CENTREVILLE AL
35034
US

V. Phone/Fax

Practice location:
  • Phone: 205-926-3284
  • Fax: 205-926-4275
Mailing address:
  • Phone: 205-926-3284
  • Fax: 205-926-4275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number21418
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME96736
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21418
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: