MEDICARE: RICHLAND PRIMARY CARE CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1841399946
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHLAND PRIMARY CARE CENTER

Provider Business Mailing Address
First Line	:	PO BOX 180367
Second Line	:
City	:	RICHLAND
State	:	MS
Zip	:	39218-0367
Country	:	US
Telephone Number	:	601-932-6400
Fax Number	:	601-932-6437

Provider Business Practice Location Address
First Line	:	1201 HIGHWAY 49 S
Second Line	:	SUITE 4
City	:	RICHLAND
State	:	MS
Zip	:	39218-9425
Country	:	US
Telephone Number	:	601-932-6400
Fax Number	:	601-932-6437

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WAYNE C JOHNSON JR.
Credential	:	M.D.
Telephone Number	:	601-932-6400

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	02/20/2020

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1225087588 — DR. WAYNE C JOHNSON JR. M.D.
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Practice Location Address:

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1144367368 — MR. JAMES A MARX C.F.N.P.
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Practice Fax: 601-932-6437

Directions to “RICHLAND PRIMARY CARE CENTER ” Practice Location

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