Provider Demographics
NPI:1568465482
Name:RICHARDSON, BRENDA J (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:J
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 381287
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38183-1287
Mailing Address - Country:US
Mailing Address - Phone:901-507-3100
Mailing Address - Fax:901-507-3167
Practice Address - Street 1:7205 WOLF RIVER BLVD
Practice Address - Street 2:STE 201
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1746
Practice Address - Country:US
Practice Address - Phone:901-507-3100
Practice Address - Fax:901-507-3167
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2011-08-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNMD018089207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3841017Medicaid
TN3841017Medicaid
TNA99405Medicare UPIN