PREMIER INTERNAL MEDICINE
Osteopathic Medicine at Wendy Bagwell Pkwy, Hiram, GA

License number
Georgia 039295
Category
Osteopathic Medicine
Type
Internal Medicine
Owner
Name: DR. RICHARD J BRECKWOLDT M.D.
Title: MEDICAL DIRECTOR
Phone: (678) 384-0800
Address
Address
5604 Wendy Bagwell Pkwy STE 711, Hiram, GA 30141
National Provider ID: 1659494847
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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PREMIER INTERNAL MEDICINE, PC

5604 Wendy Bagwell Pkwy SUITE 711, Hiram, GA 30141

Industry:
Medical Doctor's Office
Doing business as:
Premier Internal Medicine, P.C
Registration:
Sep 21, 2005
State ID:
0564660
Business type:
Domestic Professional Corporation
Secretary, Chief Financial Officers:
Richard J. Breckwoldt (Medical Director, Medical Doctor, Principal, Chief Executive Officer),J. Richard Breckwoldt (CEO), 5604 Wendy Bagwell Pkwy #13, Hiram, GA 30141 (Physical),Michelle Breckwoldt Secretary, Chief Financial Officer, inactive, 5969 Downington Rdg, Acworth, GA 30101 (Physical)
Agent:
Richard John Breckwoldt,5604 Wendy Bagwell Pkwy SUITE 711 HIRAM GA, Acworth, GA 30101 (Physical)

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