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General NPI Number Information
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NPI Number | 1215106190
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Entity Type | Organization
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Legal Business Name | ALPHARETTA GASTROENTEROLOGY ASSOC., P.C.
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Dates
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Enumeration Date | 02/26/2008
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Last Update Date | 02/26/2008
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Provider Practice Location Address
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Address Line | 11660 ALPHARETTA HWY SUITE 420
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City | ROSWELL
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State | GA
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Zip | 30076-4943
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Country | US
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Telephone | 770-442-5882
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Fax | 770-664-6134
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Provider Business Mailing Address
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Address Line | 11660 ALPHARETTA HWY SUITE 420
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City | ROSWELL
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State | GA
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Zip | 30076-4943
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Country | US
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Telephone | 770-442-5882
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Fax | 770-664-6134
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MEREDITH THOMAS RIDDICK
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Credential | M.D.
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Telephone | 770-442-5882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 022269
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License Number State | GA
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