Provider Demographics
NPI:1669705737
Name:JOHN J RICHARDS MD PC
Entity type:Organization
Organization Name:JOHN J RICHARDS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-361-6126
Mailing Address - Street 1:645 MCQUEEN SMITH ROAD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066
Mailing Address - Country:US
Mailing Address - Phone:334-361-6126
Mailing Address - Fax:334-361-6177
Practice Address - Street 1:645 MCQUEEN SMITH ROAD
Practice Address - Street 2:SUITE 205
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066
Practice Address - Country:US
Practice Address - Phone:334-361-6126
Practice Address - Fax:334-361-6177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13584174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty