Provider Demographics
NPI:1922854280
Name:MEIGS, RICHARD (RBT)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:MEIGS
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 844
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-0844
Mailing Address - Country:US
Mailing Address - Phone:470-407-7784
Mailing Address - Fax:
Practice Address - Street 1:3136 GOLF RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1952
Practice Address - Country:US
Practice Address - Phone:877-288-4760
Practice Address - Fax:404-600-1259
Is Sole Proprietor?:No
Enumeration Date:2024-04-27
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-24-332427106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician