Provider Demographics
NPI:1346336203
Name:RIVERTOWN PEDIATRICS, P.C.
Entity Type:Organization
Organization Name:RIVERTOWN PEDIATRICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDBETTER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:706-327-1281
Mailing Address - Street 1:2416 CAPSTONE CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-2795
Mailing Address - Country:US
Mailing Address - Phone:706-327-1281
Mailing Address - Fax:
Practice Address - Street 1:2416 CAPSTONE CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-2795
Practice Address - Country:US
Practice Address - Phone:706-327-1281
Practice Address - Fax:706-576-9714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1528173036Medicaid
GA1558457549Medicaid
GA1780791657Medicaid
GA1275649758Medicaid
GA1073756169Medicaid
GA1235225541Medicaid
GA1861509812Medicaid