Provider Demographics
NPI:1265409072
Name:RICHARDSON, JAMES THOMAS (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:THOMAS
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 116187
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-6187
Mailing Address - Country:US
Mailing Address - Phone:912-856-9875
Mailing Address - Fax:803-749-3929
Practice Address - Street 1:4700 WATERS AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6220
Practice Address - Country:US
Practice Address - Phone:912-350-8490
Practice Address - Fax:912-350-8819
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI343672085R0001X
GA0620772085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32444-700Medicaid
G67620Medicare UPIN
683950004Medicare ID - Type Unspecified