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General NPI Number Information
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NPI Number | 1861477127
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Entity Type | Individual
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Provider Name | KENNETH JOE RICHARDSON MD
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Gender | Male
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Dates
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Enumeration Date | 12/09/2005
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Last Update Date | 06/01/2023
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Provider Practice Location Address
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Address Line | 1825 PARK PLACE
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City | MONTGOMERY
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State | AL
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Zip | 36117-3439
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Country | US
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Telephone | 334-293-8747
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Fax | 334-834-2185
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Provider Business Mailing Address
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Address Line | 1825 PARK PLACE
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City | MONTGOMERY
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State | AL
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Zip | 36117-3439
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Country | US
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Telephone | 334-293-8747
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Fax | 334-834-2185
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 00019405
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License Number State | AL
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