Individual
CHRISTOPHER ETHERIDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3918 HERITAGE POINTE, LITHONIA, GA 30038-4078
(770) 895-4287
Mailing address
3918 HERITAGE POINTE, LITHONIA, GA 30038-4078
(770) 895-4287
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
09/20/2016
Last updated
09/20/2016
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