Provider Demographics
NPI:1669453098
Name:RICHARDSON, JAMES WHITESIDE JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WHITESIDE
Last Name:RICHARDSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1222 TROTWOOD AVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-6436
Mailing Address - Country:US
Mailing Address - Phone:931-380-3033
Mailing Address - Fax:931-388-3401
Practice Address - Street 1:1222 TROTWOOD AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-6436
Practice Address - Country:US
Practice Address - Phone:931-380-3033
Practice Address - Fax:931-388-3401
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD117212086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3033757Medicaid
TND71866Medicare UPIN
TN3033757Medicaid