Organization
RIVERSTONEMD PC
Active
Other names
RIVERSTONEMD RURAL HEALTH CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
PEGGY TRIGG (CREDENTIALING MANAGER)
(706) 258-4142
Entity
Organization
Contact information
Practice address
101 RIVERSTONE VIS, SUITE 205, BLUE RIDGE, GA 30513-6648
(706) 258-4100
(706) 632-3585
Mailing address
101 RIVERSTONE VIS, BLUE RIDGE, GA 30513-6648
(706) 258-4100
(706) 632-3585
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
032826
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000621244A
—
GA
Enumeration date
06/26/2006
Last updated
03/25/2015
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