DR. CHARLES DAVID RICHARDSON II D.O.
NPI 1942640388
Psychiatry & Neurology - Neurodevelopmental Disabilities in Hattiesburg, MS

Q: What is Charles Richardson's NPI number?

The NPI number for Charles Richardson is 1942640388. It was assigned to this individual provider in the NPPES registry on June 30, 2013.

Q: What is Charles Richardson's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Neurodevelopmental Disabilities, with taxonomy code 2084P0005X.

Active since June 30, 2013PECOS EnrolledAccepts Medicare Assignment

2117 BROADWAY DRIVE, HATTIESBURG, MS 39402(601) 288-8050(601) 288-8058 Get Directions Write a Review

NPPES record last updated: February 24, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Feb 24, 2025, Dec 2, 2019, Sep 6, 2019 (3 updates tracked since 2019).

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About Dr. Charles David Richardson Ii D.o. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. CHARLES DAVID RICHARDSON II D.O. (NPI 1942640388) is an individual neurodevelopmental disabilities provider in Hattiesburg, Mississippi, licensed in Mississippi (24662) and active in the NPI registry since June 2013. He is enrolled in Medicare PECOS, maintains a secondary practice location in Hattiesburg, and is a graduate of Other (2013).

NPPES Registry Identity

NPI1942640388

Entity TypeIndividualMale

Primary Taxonomy2084P0005X

Provider Legal NameDR. CHARLES DAVID RICHARDSON IICredential: D.O.

Location Address2117 BROADWAY DRIVEHattiesburg, MS 39402-3210

Mailing Address2117 Broadway DriveHattiesburg, MS 39402-3210 · (601) 288-8050 · Fax (601) 288-8058

Phone(601) 288-8050

Fax(601) 288-8058

Sole ProprietorYes

Medical School CMSOtherGraduated 2013

Enumeration DateJune 30, 2013

Last NPPES UpdateFebruary 24, 20253 updates tracked since enumeration

✔ NPI 1942640388 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPsychiatry & Neurology · Neurodevelopmental DisabilitiesAllopathic & Osteopathic Physicians

Taxonomy Code2084P0005X

License✔ Licensed in MS · 24662

Definition

A neurologist who specializes in the treatment of individuals with developmental delays and learning disorders associated with cerebral palsy, spina bifida, autism, and other chronic neurologic conditions.

Also ListedPsychiatry & Neurology · PsychiatryTaxonomy 2084P0800X · License 24662 (MS)

2117 BROADWAY DRIVE, Hattiesburg, MS 39402

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Secondary Practice Location 1

Location 1Merit Health Medical Group-Sr Behavioral Health, 5001 Hardy StreetHattiesburg, MS 39402-1331 · Phone (601) 268-8029 · Fax (601) 268-8394

Other Identifiers 1

Other24662MS · Medical License

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter Health and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Charles David Richardson Ii D.o. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID3274840822

PECOS Enrollment IDI20180321000935

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Charles Richardson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Forrest County General Hospital

Same address

Psychiatry

2117 BROADWAY DR
Hattiesburg, MS 39402

Reassigned Medicare billing, Mississippi enrollment
248 clinicians in this Medicare group

NPI 1275710212 (601) 288-8050

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 12

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. ASHLEY HAYNES HOLFORD LCSW

Social Worker (Clinical)