Provider Demographics
NPI:1841399946
Name:RICHLAND PRIMARY CARE CENTER
Entity Type:Organization
Organization Name:RICHLAND PRIMARY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:601-932-6400
Mailing Address - Street 1:PO BOX 180367
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MS
Mailing Address - Zip Code:39218-0367
Mailing Address - Country:US
Mailing Address - Phone:601-932-6400
Mailing Address - Fax:601-932-6437
Practice Address - Street 1:1201 HIGHWAY 49 S
Practice Address - Street 2:SUITE 4
Practice Address - City:RICHLAND
Practice Address - State:MS
Practice Address - Zip Code:39218-9425
Practice Address - Country:US
Practice Address - Phone:601-932-6400
Practice Address - Fax:601-932-6437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty