| Richard J. Breckwoldt,m.d. | |
|
5604 Wendy Bagwell Pkwy Ste 711 Hiram GA 30141-7813 | |
| (678) 384-0800 | |
| (678) 384-0801 |
| Full Name | Richard J. Breckwoldt,m.d. |
|---|---|
| Speciality | Internal Medicine |
| Location | 5604 Wendy Bagwell Pkwy, Hiram, Georgia |
| Authorized Official Name and Position | Richard J Breckwoldt (MEDICAL DIRECTOR) |
| Authorized Official Contact | 6783840800 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Richard J. Breckwoldt,m.d. 5604 Wendybagwell Pkwy (hwy 278) Suite 711 Hiram GA 30141-2291 Ph: (678) 384-0800 | Richard J. Breckwoldt,m.d. 5604 Wendy Bagwell Pkwy Ste 711 Hiram GA 30141-7813 Ph: (678) 384-0800 |
| NPI Number | 1659494847 |
|---|---|
| Provider Enumeration Date | 04/10/2007 |
| Last Update Date | 09/29/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659494847 | NPI | - | NPPES |
| 000656103B | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 039295 (Georgia) | Primary |
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