Healthcare Provider Details

I. General information

NPI: 1780627356
Provider Name (Legal Business Name): HARRY LEE RICHARDSON JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 10TH AVE SW
REFORM AL
35481
US

IV. Provider business mailing address

PO BOX 670
REFORM AL
35481-0670
US

V. Phone/Fax

Practice location:
  • Phone: 205-375-6251
  • Fax: 205-375-8199
Mailing address:
  • Phone: 205-375-6251
  • Fax: 205-375-8199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number10330
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11725
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: