Provider Demographics
NPI:1336198969
Name:MERSBERGER, RICHARD A (DO)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:MERSBERGER
Suffix:
Gender:
Credentials:DO
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 12938
Mailing Address - Street 2:C/O CLINIC MANAGEMENT
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30703
Mailing Address - Country:US
Mailing Address - Phone:706-602-7800
Mailing Address - Fax:
Practice Address - Street 1:824 GI MADDOX PKWY
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:GA
Practice Address - Zip Code:30705-2147
Practice Address - Country:US
Practice Address - Phone:706-695-0561
Practice Address - Fax:706-695-8678
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055140207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA08BBSFSMedicare ID - Type Unspecified
GA135755Medicare UPIN