Provider Demographics
NPI:1114106564
Name:JEFFREY K RICHARDS MD
Entity Type:Organization
Organization Name:JEFFREY K RICHARDS MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:K
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-769-5777
Mailing Address - Street 1:1548 ASHLEY RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-5296
Mailing Address - Country:US
Mailing Address - Phone:843-769-5777
Mailing Address - Fax:843-875-2873
Practice Address - Street 1:1548 ASHLEY RIVER RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5296
Practice Address - Country:US
Practice Address - Phone:843-769-5777
Practice Address - Fax:843-875-2873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8566174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0191Medicaid
SC3658Medicare PIN
SCGP0191Medicaid