Individual
BRENTON G RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
101 MEDICAL PARK, HATTIESBURG, MS 39401
(601) 579-3000
(601) 579-5240
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 579-3000
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
17138
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00125352
—
MS
05
—
1425524
—
LA
01
—
2292729
AMERICAN ADMIN GROUP
MS
Enumeration date
08/28/2006
Last updated
07/17/2020
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