Provider Demographics
NPI:1639237340
Name:A LYNN RIDGEWAY MD PC
Entity Type:Organization
Organization Name:A LYNN RIDGEWAY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:A
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RIDGEWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-383-4473
Mailing Address - Street 1:PO BOX 2587
Mailing Address - Street 2:
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35662-2587
Mailing Address - Country:US
Mailing Address - Phone:256-383-4473
Mailing Address - Fax:256-381-5232
Practice Address - Street 1:342 COX BLVD
Practice Address - Street 2:
Practice Address - City:SHEFFIELD
Practice Address - State:AL
Practice Address - Zip Code:35660-4020
Practice Address - Country:US
Practice Address - Phone:256-383-4473
Practice Address - Fax:256-381-5232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17451174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL21679OtherBCBS
AL000021679Medicaid
AL21679Medicare ID - Type Unspecified
AL21679OtherBCBS