Organization
PREMIER INTERNAL MEDICINE
Active
Organization
PREMIER INTERNAL MEDICINE
Active
Other names
RICHARD J. BRECKWOLDT,M.D.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD J BRECKWOLDT M.D. (MEDICAL DIRECTOR)
(678) 384-0800
Entity
Organization
Contact information
Practice address
5604 WENDY BAGWELL PKWY, STE 711, HIRAM, GA 30141-7813
(678) 384-0800
(678) 384-0801
Mailing address
5604 WENDYBAGWELL PKWY (HWY 278), SUITE 711, HIRAM, GA 30141-2291
(678) 384-0800
(678) 384-0801
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
039295
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000656103B
—
GA
Enumeration date
04/10/2007
Last updated
09/29/2010
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