Healthcare Provider Details

I. General information

NPI: 1487665105
Provider Name (Legal Business Name): TODD A RICHARDS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 ROSS CLARK CIRCLE SE DOCTOR'S BUILDING SUITE 600
DOTHAN AL
36301-3007
US

IV. Provider business mailing address

1118 ROSS CLARK CIRCLE SE DOCTOR'S BUILDING SUITE 600
DOTHAN AL
36301-3007
US

V. Phone/Fax

Practice location:
  • Phone: 334-793-3900
  • Fax: 334-793-5227
Mailing address:
  • Phone: 334-793-3900
  • Fax: 334-793-5227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number27711
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: