Provider Demographics
NPI:1740596436
Name:RICHARD J. NIJEM, M.D., P.C.
Entity Type:Organization
Organization Name:RICHARD J. NIJEM, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:NIJEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-244-9800
Mailing Address - Street 1:PO BOX 1086
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31603-1086
Mailing Address - Country:US
Mailing Address - Phone:229-244-9800
Mailing Address - Fax:229-244-5998
Practice Address - Street 1:1700 N PATTERSON ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2941
Practice Address - Country:US
Practice Address - Phone:229-244-9800
Practice Address - Fax:229-244-5998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-19
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA015405207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00133262AMedicaid
GA406063797OtherRAILROAD MEDICARE
GA00133262AMedicaid