# DR. CHARLES DAVID RICHARDSON II

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1942640388
- **Gender:** Man
- **Credential:** D.O.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084P0005X | Neurodevelopmental Disabilities Physician | 24662 | MS | Yes |
| 2084P0800X | Psychiatry Physician | 24662 | MS | — |

## Other

- **Enumeration date:** 06/30/2013
- **Last updated:** 02/24/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 24662 | MEDICAL LICENSE | MS |