Healthcare Provider Details

I. General information

NPI: 1619123056
Provider Name (Legal Business Name): RICHARDSON PSYCHIATRIC P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 I 55 N STE 234
JACKSON MS
39211-5932
US

IV. Provider business mailing address

4500 I 55 N STE 234
JACKSON MS
39211-5932
US

V. Phone/Fax

Practice location:
  • Phone: 601-982-8531
  • Fax: 601-982-1115
Mailing address:
  • Phone: 601-982-8531
  • Fax: 601-982-1115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN D RICHARDSON
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 601-982-8535