1245253087 NPI number — VICKY RICHARDS DPH

Employer Identification Number (EIN)	:
Provider Organization Name (Legal Business Name)	:
Provider Last Name (Legal Name)	:	RICHARDS
Provider First Name	:	VICKY
Provider Middle Name	:
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Provider Credential Text	:	DPH
Provider Gender Code	:	F

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NPI Number	:	1245253087
Entity Type Code	:	Individual
Replacement NPI	:
Last Update Date	:	07/08/2007
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Provider First Line Business Mailing Address	:	655 E PARK ST
Provider Second Line Business Mailing Address	:
Provider Business Mailing Address City Name	:	ALAMO
Provider Business Mailing Address State Name	:	TN
Provider Business Mailing Address Postal Code	:	380011406
Provider Business Mailing Address Country Code	:	US
Provider Business Mailing Address Telephone Number	:	7316963002
Provider Business Mailing Address Fax Number	:	7316632792

Provider First Line Business Practice Location Address	:	150 HERNDON DR
Provider Second Line Business Practice Location Address	:
Provider Business Practice Location Address City Name	:	BELLS
Provider Business Practice Location Address State Name	:	TN
Provider Business Practice Location Address Postal Code	:	380063659
Provider Business Practice Location Address Country Code	:	US
Provider Business Practice Location Address Telephone Number	:	7316632314
Provider Business Practice Location Address Fax Number	:	7316632792
Provider Enumeration Date	:	07/25/2006

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• Taxonomy code: 183500000X , with the licence number:  5572 , registered in the state of TN .