Riddick Ackerman III, M.D.
Individual provider Active NPI Obstetrics & Gynecology Physician · Walterboro, SC
NPI 1104867183 · NPPES record last updated Jul 13, 2026
Key facts
- NPI
- 1104867183
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- License
- 11469 (SC)
- Practice address
- 400 Constance St
Walterboro, SC 29488-2710 - Phone
- (843) 549-9568
- Fax
- (843) 549-1530
- NPI assigned
- Jun 9, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11469 | SC | MD | General Practice Dentistry |
| 1469 | SC | MD | Optometrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 11469 | SC | Yes |
Addresses
Primary practice location
400 Constance St
Walterboro, SC 29488-2710
Mailing address
400 Constance St
Walterboro, SC 29488-2710
Phone (843) 549-9568
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 114691 | Medicaid | SC |
Other providers in Walterboro, SC
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- Amber Allen
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All providers in Walterboro, SC · Obstetrics & Gynecology Physician in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.