Individual
MR. JERRY ETHRIDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
820 ASHLEY LAINE WALK, LAWRENCEVILLE, GA 30043-4286
(229) 392-3459
Mailing address
820 ASHLEY LAINE WALK, LAWRENCEVILLE, GA 30043-4286
(229) 392-3459
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN188111
GA
Other
Enumeration date
01/14/2026
Last updated
01/14/2026
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