# BLUE RIDGE CONCIERGE MEDICINE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013504174
- **Authorized official:** RAYMOND TIDMAN MD (PRESIDENT)
- **Authorized official phone:** (706) 946-4240

## Contact information

- **Practice address:** 101 RIVERSTONE VIS STE 203, BLUE RIDGE, GA 30513-6668
- **Practice address phone:** (706) 946-4240
- **Mailing address:** 101 RIVERSTONE VIS STE 203, BLUE RIDGE, GA 30513-6668
- **Mailing address phone:** (706) 946-4240

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/23/2020
- **Last updated:** 12/23/2020