Healthcare Provider Details

I. General information

NPI: 1023072600
Provider Name (Legal Business Name): SUNDRA VICTORIA RIDLEY-BROWN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3193 HOWELL MILL RD NW STE 315
ATLANTA GA
30327-2100
US

IV. Provider business mailing address

50 OLD MOUNTAIN RD
POWDER SPRINGS GA
30127-4313
US

V. Phone/Fax

Practice location:
  • Phone: 678-596-5560
  • Fax:
Mailing address:
  • Phone: 248-814-9972
  • Fax: 248-814-9973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN251167
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: