Provider Demographics
NPI:1831181205
Name:RICHARDS, JAMES DARRYL (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:DARRYL
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:J
Other - Middle Name:DARRYL
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1130
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38503-1130
Mailing Address - Country:US
Mailing Address - Phone:931-239-0284
Mailing Address - Fax:
Practice Address - Street 1:3830 MIRANDY RD
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38506-8646
Practice Address - Country:US
Practice Address - Phone:931-239-0284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD020946207Q00000X
TNMD20946207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1509111Medicaid
TN3055058Medicaid
TN3055058Medicaid
E54864Medicare UPIN
TN3055058Medicare ID - Type Unspecified