Provider Demographics
NPI:1043574684
Name:EHRMAN H. ELDRIDGE JR MD LLC
Entity Type:Organization
Organization Name:EHRMAN H. ELDRIDGE JR MD LLC
Other - Org Name:ELDRIDGE MBS WELLNESS CENTER FOR WOMEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-323-9047
Mailing Address - Street 1:1100 18TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-1723
Mailing Address - Country:US
Mailing Address - Phone:706-323-9047
Mailing Address - Fax:706-323-9370
Practice Address - Street 1:1100 18TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1723
Practice Address - Country:US
Practice Address - Phone:706-323-9047
Practice Address - Fax:706-323-9370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-28
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA023947207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA16BDCCGOtherMEDICARE PTAN
GA312503OtherMEDICAID WELLCARE
GA000422023BMedicaid
GA11D0702751OtherMEDICARE CLIA
GA312503OtherMEDICAID WELLCARE