Provider Demographics
NPI:1144605890
Name:GOODRIDGE, TERESA
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:GOODRIDGE
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 1:1151 RIDGEVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31220-2630
Mailing Address - Country:US
Mailing Address - Phone:478-737-7915
Mailing Address - Fax:
Practice Address - Street 1:1151 RIDGEVIEW CIR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31220-2630
Practice Address - Country:US
Practice Address - Phone:478-737-7915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator