Individual
MR. BRADLEY GENE RIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Contact information
Practice address
3294 NORTH OAK ST. EXT., VALDOSTA, GA 31605
(229) 247-2290
Mailing address
3294 NORTH OAK ST. EXT., VALDOSTA, GA 31605
(229) 241-1188
(229) 245-7106
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
004094
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
723712955A
—
GA
Enumeration date
10/26/2006
Last updated
03/07/2012
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