Healthcare Provider Details

I. General information

NPI: 1679962229
Provider Name (Legal Business Name): MRS. HEATHER RIDGWAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2015
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 HILLCREST PKWY STE A
DUBLIN GA
31021-4373
US

IV. Provider business mailing address

1100 HILLCREST PKWY STE A
DUBLIN GA
31021-4373
US

V. Phone/Fax

Practice location:
  • Phone: 478-277-3085
  • Fax: 478-277-3088
Mailing address:
  • Phone: 478-277-3085
  • Fax: 478-277-3088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHI-017889
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: