Individual
DR. CHARLES DAVID RICHARDSON II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2117 BROADWAY DRIVE, HATTIESBURG, MS 39402-3210
(601) 288-8050
(601) 288-8058
Mailing address
2117 BROADWAY DRIVE, HATTIESBURG, MS 39402-3210
(601) 288-8050
(601) 288-8058
Taxonomy
Speciality
Code
Description
License number
State
2084P0005X
Neurodevelopmental Disabilities Physician
Primary
24662
MS
2084P0800X
Psychiatry Physician
24662
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
24662
MEDICAL LICENSE
MS
Enumeration date
06/30/2013
Last updated
02/24/2025
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