Charles L Ridley III, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

025476 Issued in GA

Practice address

2266 Ingleside Ave
Macon, GA 31204-2032

Phone

(478) 745-6050

NPI assigned

Aug 15, 2006

Last updated

Feb 27, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204070400000",
    "number": "1992718175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2266 INGLESIDE AVE",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312042032",
            "telephone_number": "478-745-6050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2266 INGLESIDE AVE",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312042032",
            "telephone_number": "478-745-6050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIDLEY",
        "first_name": "CHARLES",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-15",
        "last_updated": "2008-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "025476",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "279620",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Luke Rich
• Rebecca Haley Richard, LCSW
• Khiana Richardson, RBT
• Ride Away Transportation LLC
• Sonja Norris Ridlehoover, LMFT
• Gwendolyn Riggins, NP-C
• Right1 Homecare LLC
• Linda Marie Riley, MD
• Cliff Rimpel
• Christy Laine Riser, ASSISTANT RBT

• Internal Medicine Physician in Macon, GA
• Providers in Macon, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.