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General NPI Number Information
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NPI Number | 1619123056
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Entity Type | Organization
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Legal Business Name | RICHARDSON PSYCHIATRIC P.A.
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Dates
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Enumeration Date | 08/18/2008
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Last Update Date | 08/18/2008
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Provider Practice Location Address
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Address Line | 4500 I 55 N STE 234
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City | JACKSON
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State | MS
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Zip | 39211-5932
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Country | US
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Telephone | 601-982-8531
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Fax | 601-982-1115
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Provider Business Mailing Address
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Address Line | 4500 I 55 N STE 234
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City | JACKSON
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State | MS
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Zip | 39211-5932
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Country | US
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Telephone | 601-982-8531
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Fax | 601-982-1115
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. JOHN D RICHARDSON
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Credential | M.D.
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Telephone | 601-982-8535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number |
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License Number State |
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