Individual
PHILLIP PATRICK RIDEOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 S ENOTA DR NE STE 360, GAINESVILLE, GA 30501-3466
(770) 219-4000
Mailing address
PO BOX 742616, ATLANTA, GA 30374-2616
(770) 219-8420
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
6088
GA
2086S0129X
Vascular Surgery Physician
Primary
73048
GA
Other
Enumeration date
06/11/2013
Last updated
01/22/2021
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