Ridgeway Family Practice, PC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

2010001281-58996 Issued in GA

Legal business name

RIDGEWAY FAMILY PRACTICE, PC

Practice address

641 Hospital Rd
Suite 3
Commerce, GA 30529-1155

Phone

(706) 335-2034

Fax

(706) 336-8638

NPI assigned

Feb 5, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Beth Ann Sullivan, DO

Title

President

Phone

(706) 335-2034

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289952000000",
    "number": "1679612733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "641 HOSPITAL RD",
            "address_2": "SUITE 3",
            "city": "COMMERCE",
            "state": "GA",
            "postal_code": "305291155",
            "telephone_number": "706-335-2034",
            "fax_number": "706-336-8638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "641 HOSPITAL RD",
            "address_2": "SUITE 3",
            "city": "COMMERCE",
            "state": "GA",
            "postal_code": "305291155",
            "telephone_number": "706-335-2034",
            "fax_number": "706-336-8638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIDGEWAY FAMILY PRACTICE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-05",
        "last_updated": "2010-11-17",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "BETH",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "706-335-2034",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "GA",
            "license": "2010001281-58996",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "GRP6629",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "85002412G",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Restoration Healthcare
• Restoration Healthcare of Commerce LLC
• Restoration Healthcare of Commerce LLC
• Restoration Healthcare of Commerce, LLC
• Restoration Healthcare of Commerce, LLC
• Brenda E Rosado Gonzalez, O.D., MBA
• Jennifer Kay Rubner, CPNP-PC
• Raedeen S Russell, PHD
• David M Russo
• Samuel K Thomason DMD PC

• Primary Care Clinic/Center in Commerce, GA
• Providers in Commerce, GA by specialty
• Primary Care Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.