Provider Demographics
NPI:1508962911
Name:RICHARDS, BARTLEY R (DO)
Entity Type:Individual
Prefix:
First Name:BARTLEY
Middle Name:R
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1654 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:GA
Mailing Address - Zip Code:30549-2666
Mailing Address - Country:US
Mailing Address - Phone:706-367-5006
Mailing Address - Fax:706-367-7711
Practice Address - Street 1:1654 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:GA
Practice Address - Zip Code:30549-2666
Practice Address - Country:US
Practice Address - Phone:706-367-5006
Practice Address - Fax:706-367-7711
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033883207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000511662DMedicaid
GA08BBMedicare ID - Type Unspecified
GA000511662DMedicaid