Provider Demographics
NPI:1033195375
Name:GOODRIDGE, CHRISTINA LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:LYNN
Last Name:GOODRIDGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4224 HOUMA BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2933
Mailing Address - Country:US
Mailing Address - Phone:504-888-2080
Mailing Address - Fax:504-454-5001
Practice Address - Street 1:421 S 28TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7208
Practice Address - Country:US
Practice Address - Phone:601-268-5640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16873207V00000X
LA023094207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1484261Medicaid
5H331Medicare ID - Type Unspecified
H21769Medicare UPIN