Provider Demographics
NPI:1821482464
Name:RICHARDSON, ADAM (DO, FAAD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:DO, FAAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 WATERMELON RD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473-5204
Mailing Address - Country:US
Mailing Address - Phone:205-345-1520
Mailing Address - Fax:205-332-3714
Practice Address - Street 1:4410 WATERMELON RD
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473-5204
Practice Address - Country:US
Practice Address - Phone:205-345-1520
Practice Address - Fax:205-332-3714
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-21
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO.2171207N00000X, 207ND0101X
MI5101024510207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatology