MEDICARE: IRMA RIDDICK

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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1770448664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRMA RIDDICK

Provider Business Mailing Address
First Line	:	111 PINE VALLEY DR
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29483-5198
Country	:	US
Telephone Number	:	706-504-7680
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 PINE VALLEY DR
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29483-5198
Country	:	US
Telephone Number	:	706-504-7680
Fax Number	:

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

Provider Enumeration Date	:	12/22/2025
Last Update Date	:	01/20/2026

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Directions to “ IRMA RIDDICK ” Practice Location

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