Provider Demographics
NPI:1417966706
Name:RICHARDS, J T (MD)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:T
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2 WHARFSIDE ST
Mailing Address - Street 2:4-F
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-1652
Mailing Address - Country:US
Mailing Address - Phone:843-720-7823
Mailing Address - Fax:843-577-2227
Practice Address - Street 1:2 WHARFSIDE ST
Practice Address - Street 2:4-F
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-1652
Practice Address - Country:US
Practice Address - Phone:843-720-7823
Practice Address - Fax:843-577-2227
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2010-05-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC4706208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC047069Medicaid
SCGP0023Medicaid
SC900005211OtherTAX ID
SC047069Medicaid
SCD991437232Medicare ID - Type Unspecified