MEDICARE: SUNDRA VICTORIA RIDLEY-BROWN CRNA

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	367500000X	Certified Registered Nurse Anesthetist	RN251167	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	SR109816	OTHER	MI	BLUE CROSS OF MI

General Provider Information

NPI Number	:	1023072600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUNDRA VICTORIA RIDLEY-BROWN CRNA

Provider Business Mailing Address
First Line	:	50 OLD MOUNTAIN RD
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-4313
Country	:	US
Telephone Number	:	248-814-9972
Fax Number	:	248-814-9973

Provider Business Practice Location Address
First Line	:	3193 HOWELL MILL RD NW STE 315
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-2100
Country	:	US
Telephone Number	:	678-596-5560
Fax Number	:

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

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	12/10/2025

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