Provider Demographics
NPI:1730121286
Name:REDMOND PHYSICIAN PRACTICE COMPANY
Entity Type:Organization
Organization Name:REDMOND PHYSICIAN PRACTICE COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:RYDBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-373-7600
Mailing Address - Street 1:2112 SHORTER AVE NW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-2018
Mailing Address - Country:US
Mailing Address - Phone:706-233-4000
Mailing Address - Fax:706-233-4006
Practice Address - Street 1:2112 SHORTER AVE NW
Practice Address - Street 2:SUITE 200
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2018
Practice Address - Country:US
Practice Address - Phone:706-233-4000
Practice Address - Fax:706-233-4006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CB6391Medicare PIN
GA5894650001Medicare NSC
GAGRP2870Medicare PIN