Healthcare Provider Details

I. General information

NPI: 1164454542
Provider Name (Legal Business Name): CHRISTOPHER P RITCHEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MEDICAL CENTER BLVD
LAWRENCEVILLE GA
30046-7694
US

IV. Provider business mailing address

2331 RABBIT FARM CIR
LOGANVILLE GA
30052-4245
US

V. Phone/Fax

Practice location:
  • Phone: 678-312-3317
  • Fax:
Mailing address:
  • Phone: 337-258-1863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number017865
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number017865
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number70417
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: