MEDICARE: LAKIJA RIDLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	710761	GA

General Provider Information

NPI Number	:	1003770033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKIJA RIDLEY

Provider Business Mailing Address
First Line	:	5617 WAVERLY PARK
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-2725
Country	:	US
Telephone Number	:	404-323-5088
Fax Number	:

Provider Business Practice Location Address
First Line	:	5617 WAVERLY PARK
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-2725
Country	:	US
Telephone Number	:	404-323-5088
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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Directions to “ LAKIJA RIDLEY ” Practice Location

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