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General NPI Number Information
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NPI Number | 1578620480
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Entity Type | Organization
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Legal Business Name | TRICIA ETHERIDGE, MD, PC
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 109 S GREEN ST
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City | RIDGELAND
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State | SC
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Zip | 29936-9165
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Country | US
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Telephone | 843-726-6773
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Fax | 843-726-6778
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Provider Business Mailing Address
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Address Line | PO BOX 999
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City | RIDGELAND
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State | SC
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Zip | 29936-2616
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Country | US
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Telephone | 843-726-6773
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Fax | 843-726-6778
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. TINA MARIE MURDAUGH
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Credential |
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Telephone | 843-726-6773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 19547
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License Number State | SC
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