Healthcare Provider Details

I. General information

NPI: 1841399946
Provider Name (Legal Business Name): RICHLAND PRIMARY CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 HIGHWAY 49 S SUITE 4
RICHLAND MS
39218-9425
US

IV. Provider business mailing address

PO BOX 180367
RICHLAND MS
39218-0367
US

V. Phone/Fax

Practice location:
  • Phone: 601-932-6400
  • Fax: 601-932-6437
Mailing address:
  • Phone: 601-932-6400
  • Fax: 601-932-6437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WAYNE C JOHNSON JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 601-932-6400