# RICHARDSON PSYCHIATRIC P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619123056
- **Authorized official:** DR. JOHN D RICHARDSON M.D. (OWNER/PRESIDENT)
- **Authorized official phone:** (601) 982-8535

## Contact information

- **Practice address:** 4500 I 55 N STE 234, JACKSON, MS 39211-5932
- **Practice address phone:** (601) 982-8531
- **Practice address fax:** (601) 982-1115
- **Mailing address:** 4500 I 55 N STE 234, JACKSON, MS 39211-5932
- **Mailing address phone:** (601) 982-8531
- **Mailing address fax:** (601) 982-1115

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084P0805X | Geriatric Psychiatry Physician | — | NULL | Yes |
| 2084P0805X | Geriatric Psychiatry Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/18/2008
- **Last updated:** 08/18/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00119784 | — | MS |
| 05 | — | 1409871 | — | LA |
| 01 | — | 587948354B | BLUE CROSS BLUE SHIELD | MS |