Healthcare Provider Details

I. General information

NPI: 1578766671
Provider Name (Legal Business Name): DR. RICHARD C. ANDERSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 494
COCHRAN GA
31014-0494
US

IV. Provider business mailing address

PO BOX 494
COCHRAN GA
31014-0494
US

V. Phone/Fax

Practice location:
  • Phone: 478-934-4763
  • Fax: 478-934-8080
Mailing address:
  • Phone: 478-934-4763
  • Fax: 478-934-8080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN126365 NP
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberRN052713
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9790
License Number StateGA

VIII. Authorized Official

Name: NAN H. ANDERSON
Title or Position: OFFICE MANAGER
Credential: R.N.
Phone: 478-934-4763