person
Richard M Proenza, PA-C
Surgical Physician Assistant in Vidalia, Georgia
NPI 1982693024

Richard M Proenza is a Surgical Physician Assistant based in Vidalia, GA and is specialized in Surgical. Richard M Proenza practices in Vidalia, GA and has the professional credentials of PA-C. The NPI Number for Richard M Proenza is 1982693024 and holds a License No. 004304 (Georgia).

The current practice location address for Richard M Proenza is 3301 E 1St St, Vidalia, GA and can be reached out via phone at 912-537-4411 and via fax at 912-538-8485.

Location: 3301 E 1St St, Vidalia, GA, 30474-8674
person
Provider Profile Details
NPI Number
1982693024
Provider Name
Richard M Proenza
Credential
PA-C
Provider Entity Type
Individual
Gender
Male
Address
3301 E 1St St, Vidalia, GA, 30474-8674
Phone Number
912-537-4411
Fax Number
912-538-8485
Provider Enumeration Date
10/20/2005
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
954937257E 05 GA
954937257F 05 GA
institution
Provider Business Practice Location Address Details
Address
3301 E 1St St
City
State
Zip
30474-8674
Phone Number
912-537-4411
Fax Number
912-538-8485
person
Provider Business Mailing Address Details
Address
3301 E 1St St
City
State
Zip
30474-8674
Phone Number
912-537-4411
Fax Number
912-538-8485
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Surgical
Taxonomy
License No.
004304 (Georgia)
Definition
Definition to come...
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