Provider Demographics
NPI:1154443703
Name:LOCKRIDGE, MARTHA S (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:S
Last Name:LOCKRIDGE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 FAIRMONT DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-7709
Mailing Address - Country:US
Mailing Address - Phone:931-381-4146
Mailing Address - Fax:
Practice Address - Street 1:206 LEGION AVE
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:TN
Practice Address - Zip Code:37091-2898
Practice Address - Country:US
Practice Address - Phone:931-359-1551
Practice Address - Fax:931-359-0542
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN153234163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse