Individual
MR. JONATHAN R RIDENOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2105 E SOUTH BLVD, MONTGOMERY, AL 36116-2409
(334) 288-2100
Mailing address
8400 COUNTRY CLUB WAY, APT. L29, KNOXVILLE, TN 37923-1844
(865) 567-2465
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.1244
AL
Other
Enumeration date
04/19/2017
Last updated
04/19/2017
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