=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598896144
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT W RICHARDS M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2007
-----------------------------------------------------
Last Update Date | 09/13/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 246 ADLEY WAY
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29607-6511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-288-0330
-----------------------------------------------------
Fax | 864-288-0350
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 246 ADLEY WAY
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29607-6511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-288-0330
-----------------------------------------------------
Fax | 864-288-0350
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 16540
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 16540
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------