Provider Demographics
NPI:1003409806
Name:BALDRIDGE, FREDDIE L
Entity Type:Individual
Prefix:MRS
First Name:FREDDIE
Middle Name:L
Last Name:BALDRIDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 TOBACCO RD STE I
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-8112
Mailing Address - Country:US
Mailing Address - Phone:706-305-1102
Mailing Address - Fax:
Practice Address - Street 1:2215 TOBACCO RD STE I
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-8112
Practice Address - Country:US
Practice Address - Phone:706-305-1102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator