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General NPI Number Information
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NPI Number | 1053378505
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Entity Type | Organization
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Legal Business Name | MID-SOUTH SURGEONS, PLLC
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Dates
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Enumeration Date | 04/27/2006
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Last Update Date | 01/14/2010
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Provider Practice Location Address
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Address Line | 1222 TROTWOOD AVE SUITE 211
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City | COLUMBIA
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State | TN
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Zip | 38401-6436
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Country | US
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Telephone | 931-380-3033
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Fax | 931-388-3401
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Provider Business Mailing Address
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Address Line | 1222 TROTWOOD AVE SUITE 211
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City | COLUMBIA
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State | TN
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Zip | 38401-6436
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Country | US
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Telephone | 931-380-3033
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Fax | 931-388-3401
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Authorized Official
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Title or Position | PHY PARTNER
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Name | JAMES W RICHARDSON JR.
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Credential | M.D.
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Telephone | 931-380-3033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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