Healthcare Provider Details

I. General information

NPI: 1568626943
Provider Name (Legal Business Name): RICHARD WILSON USSERY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 BARFIELD DR
DUBLIN GA
31021-0491
US

IV. Provider business mailing address

307 BARFIELD DR
DUBLIN GA
31021-0491
US

V. Phone/Fax

Practice location:
  • Phone: 478-275-7614
  • Fax:
Mailing address:
  • Phone: 478-275-7614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW001815
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: