Organization
BLUE RIDGE CONCIERGE MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAYMOND TIDMAN MD (PRESIDENT)
(706) 946-4240
Entity
Organization
Contact information
Practice address
101 RIVERSTONE VIS STE 203, BLUE RIDGE, GA 30513-6668
(706) 946-4240
Mailing address
101 RIVERSTONE VIS STE 203, BLUE RIDGE, GA 30513-6668
(706) 946-4240
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
32826
LICENSE
GA
Enumeration date
12/23/2020
Last updated
12/23/2020
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