Individual
RICHARD J BRECKWOLDT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5604 WENDY BAGWELL PKWY, SUITE 711, HIRAM, GA 30141-7813
(678) 384-0800
(678) 384-0801
Mailing address
5604 WENDY BAGWELL PKWY, SUITE 711, HIRAM, GA 30141-7813
(678) 384-0800
(678) 384-0801
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
039295
GA
207R00000X
Internal Medicine Physician
39295
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000656103B
—
GA
Enumeration date
10/04/2005
Last updated
06/16/2014
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