Provider Demographics
NPI:1174637946
Name:RICHARDS, RANDOLPH M (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDOLPH
Middle Name:M
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-851-6033
Mailing Address - Fax:615-851-2018
Practice Address - Street 1:787 WEATHERLY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8949
Practice Address - Country:US
Practice Address - Phone:931-647-1255
Practice Address - Fax:931-647-2399
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21029207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ012480Medicaid
TN62186005901OtherAMERICHOICE
6039655OtherBLUECROSS
TN621860059OtherTRICARE
TNQ012480Medicaid