Provider Demographics
NPI:1164464814
Name:R LITTLE ENTERPRISES INC
Entity Type:Organization
Organization Name:R LITTLE ENTERPRISES INC
Other - Org Name:CONNIE STAPLETON PHD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STAPLETON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:706-364-5228
Mailing Address - Street 1:2915 PROFESSIONAL PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-6521
Mailing Address - Country:US
Mailing Address - Phone:706-364-5228
Mailing Address - Fax:706-364-5229
Practice Address - Street 1:2915 PROFESSIONAL PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-6521
Practice Address - Country:US
Practice Address - Phone:706-364-5228
Practice Address - Fax:706-364-5229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2412103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA497373OtherVALUE OPTIONS
GA52821111-001OtherBCBS ID#
GA52821111-001OtherBCBS ID#
GAQ64034Medicare UPIN