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General NPI Number Information
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NPI Number | 1023230620
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Entity Type | Organization
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Legal Business Name | BARTLEY R. RICHARDS, DO PC
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 06/24/2013
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Provider Practice Location Address
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Address Line | 1654 WASHINGTON ST
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City | JEFFERSON
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State | GA
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Zip | 30549-2666
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Country | US
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Telephone | 706-367-5006
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Fax | 706-367-7711
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Provider Business Mailing Address
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Address Line | 1654 WASHINGTON ST
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City | JEFFERSON
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State | GA
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Zip | 30549-2666
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Country | US
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Telephone | 706-367-5006
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Fax | 706-367-7711
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Authorized Official
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Title or Position | CEO
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Name | BARTLEY RUARK RICHARDS
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Credential | D.O.
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Telephone | 706-367-5006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 033883
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License Number State | GA
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