Healthcare Provider Details

I. General information

NPI: 1922186535
Provider Name (Legal Business Name): DAVID D RICHARDSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 02/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2659 LAKELAND DR STE C
FLOWOOD MS
39232-9516
US

IV. Provider business mailing address

2659 LAKELAND DR STE C
FLOWOOD MS
39232-9516
US

V. Phone/Fax

Practice location:
  • Phone: 601-957-2273
  • Fax:
Mailing address:
  • Phone: 601-957-2273
  • Fax: 601-977-0580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number08793
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: