Individual
WILLIE D RICHARDSON SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8316 MACON TER STE 102, CORDOVA, TN 38018-8505
(901) 624-0371
(901) 624-0375
Mailing address
8316 MACON TER STE 102, CORDOVA, TN 38018-8505
(901) 624-0371
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
L000000022609
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q018034
—
TN
Enumeration date
12/10/2018
Last updated
12/10/2018
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