Individual
LEE ANN TIDMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
101 RIVERSTONE VIS, SUITE 205, BLUE RIDGE, GA 30513-6648
(706) 632-4400
(706) 632-4404
Mailing address
101 RIVERSTONE VIS, BLUE RIDGE, GA 30513-6648
(706) 632-4400
(706) 632-4404
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN043489
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000498165F
—
GA
Enumeration date
07/21/2005
Last updated
05/09/2011
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