Healthcare Provider Details

I. General information

NPI: 1275449423
Provider Name (Legal Business Name): CHANNING RITTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5721 USA NORTH DRIVE
MOBILE AL
36688-0001
US

IV. Provider business mailing address

107 WILDER AVE
CHICKAMAUGA GA
30707-1121
US

V. Phone/Fax

Practice location:
  • Phone: 334-398-0546
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-180601
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: