Provider Demographics
NPI:1023230620
Name:BARTLEY R. RICHARDS, DO PC
Entity type:Organization
Organization Name:BARTLEY R. RICHARDS, DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BARTLEY
Authorized Official - Middle Name:RUARK
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:706-367-5006
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033883261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center