Provider Demographics
NPI:1003878547
Name:FRIERSON, RICHARD LESESNE (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LESESNE
Last Name:FRIERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3904
Mailing Address - Country:US
Mailing Address - Phone:803-296-7320
Mailing Address - Fax:803-296-7330
Practice Address - Street 1:15 MEDICAL PARK RD
Practice Address - Street 2:SUITE 301
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-8003
Practice Address - Country:US
Practice Address - Phone:803-255-3400
Practice Address - Fax:803-255-3420
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC144442084P0800X, 2084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC144445Medicaid
E56061Medicare UPIN
SCE560614411Medicare PIN
E560614411Medicare ID - Type Unspecified