Organization
RICHARDSON PSYCHIATRIC P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN D RICHARDSON M.D. (OWNER/PRESIDENT)
(601) 982-8535
Entity
Organization
Contact information
Practice address
4500 I 55 N STE 234, JACKSON, MS 39211-5932
(601) 982-8531
(601) 982-1115
Mailing address
4500 I 55 N STE 234, JACKSON, MS 39211-5932
(601) 982-8531
(601) 982-1115
Taxonomy
Speciality
Code
Description
License number
State
2084P0805X
Geriatric Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00119784
—
MS
05
—
1409871
—
LA
01
—
587948354B
BLUE CROSS BLUE SHIELD
MS
Enumeration date
08/18/2008
Last updated
08/18/2008
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