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General NPI Number Information
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NPI Number | 1639147549
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Entity Type | Organization
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Legal Business Name | FLINT RIVER PRIMARY CARE
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Dates
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Enumeration Date | 03/08/2006
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Last Update Date | 02/07/2008
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Provider Practice Location Address
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Address Line | 502 SUMTER ST
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City | MONTEZUMA
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State | GA
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Zip | 31063-1734
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Country | US
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Telephone | 478-472-6713
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Fax | 478-472-5142
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Provider Business Mailing Address
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Address Line | 502 SUMTER ST
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City | MONTEZUMA
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State | GA
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Zip | 31063-1734
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Country | US
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Telephone | 478-472-6713
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Fax | 478-472-5142
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Authorized Official
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Title or Position | PHYSICIAN
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Name | CHRISTOPHER STERLING RICHARDS
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Credential | M.D.
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Telephone | 478-472-6713
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 058316
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License Number State | GA
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