Organization
ROBERT S RIDDICK MDPC
Active
Other names
Riddick Surgical Services
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT STEVEN RIDDICK MD (PHYSICIAN OWNER)
(912) 538-8545
Entity
Organization
Contact information
Practice address
106 QUEEN STREET, SUITE 4, VIDALIA, GA 30474
(912) 538-8545
(912) 538-8547
Mailing address
PO BOX 1047, VIDALIA, GA 30475-1047
(912) 538-8545
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
054933
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GRP6799
MEDICARE GROUP NUMBER
GA
Enumeration date
05/23/2007
Last updated
12/28/2007
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