Organization
RIDGEWAY FAMILY PRACTICE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BETH ANN SULLIVAN DO (PRESIDENT)
(706) 335-2034
Entity
Organization
Contact information
Practice address
641 HOSPITAL RD, SUITE 3, COMMERCE, GA 30529-1155
(706) 335-2034
(706) 336-8638
Mailing address
641 HOSPITAL RD, SUITE 3, COMMERCE, GA 30529-1155
(706) 335-2034
(706) 336-8638
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
2010001281-58996
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
85002412G
—
GA
01
—
GRP6629
MEDICARE GROUP NUMBER
GA
Enumeration date
02/05/2007
Last updated
11/17/2010
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