Provider Demographics
NPI:1982887923
Name:RICHARD J. NIJEM & WILLIAM C NIJEM PTR
Entity Type:Organization
Organization Name:RICHARD J. NIJEM & WILLIAM C NIJEM PTR
Other - Org Name:NIJEM AND NIJEM MDS
Other - Org Type:Other Name
Authorized Official - Title/Position:DR.
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 1:1700 N PATTERSON ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2941
Mailing Address - Country:US
Mailing Address - Phone:229-244-9800
Mailing Address - Fax:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA15405207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACN9373OtherRAILROAD MEDICARE
GAGRP1442Medicare PIN
GAD30352Medicare UPIN