| Bertha Richardsaon | |
|
1614 Carswell Ave Waycross GA 31503 | |
| (912) 285-5171 | |
| (912) 449-7111 |
| Full Name | Bertha Richardsaon |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1614 Carswell Ave, Waycross, Georgia |
| Authorized Official Name and Position | Bobby Brown (CEO) |
| Authorized Official Contact | 9124497111 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bertha Richardsaon 1007 Mary St Waycross GA 31503-3823 Ph: (912) 449-7111 | Bertha Richardsaon 1614 Carswell Ave Waycross GA 31503 Ph: (912) 285-5171 |
| NPI Number | 1770855868 |
|---|---|
| Provider Enumeration Date | 02/03/2012 |
| Last Update Date | 02/03/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770855868 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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