Bartley R. Richards, DO PC
Organization Active NPI Clinic/Center · Jefferson, GA
NPI 1023230620 · NPPES record last updated Jun 24, 2013
Key facts
- NPI
- 1023230620
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- License
- 033883 (GA)
- Legal business name
- BARTLEY R. RICHARDS, DO PC
- Practice address
- 1654 Washington St
Jefferson, GA 30549-2666 - Phone
- (706) 367-5006
- Fax
- (706) 367-7711
- NPI assigned
- May 3, 2007
- Organization subpart
- No
Authorized official
- Name
- Bartley Ruark Richards, D.O.
- Title
- Ceo
- Phone
- (706) 367-5006
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041014000050 | GA | Part B Supplier - Clinic/Group Practice | 0840250833 |
Receives reassigned benefits from 1 practitioner Practice locations: Jefferson, GA |
National Provider Directory
Locations
1654 Washington St
Jefferson, GA 30549
Phone (706) 367-5006
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | 033883 | GA | Yes |
Addresses
Primary practice location
1654 Washington St
Jefferson, GA 30549-2666
Mailing address
1654 Washington St
Jefferson, GA 30549-2666
Phone (706) 367-5006
Other providers in Jefferson, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 24, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.