Provider Demographics
NPI:1790893402
Name:PRIDGEN, HENRY ALBERT III (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:ALBERT
Last Name:PRIDGEN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1227
Mailing Address - Street 2:406 WEST FIRST AVENUE
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31702-1227
Mailing Address - Country:US
Mailing Address - Phone:229-439-9400
Mailing Address - Fax:229-436-3718
Practice Address - Street 1:406 W 1ST AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-2202
Practice Address - Country:US
Practice Address - Phone:229-439-9400
Practice Address - Fax:229-436-3718
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2023-02-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN64974207L00000X
GA048294207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000866126AMedicaid
GA728846OtherBLUE CROSS BLUE SHIELD
GA050074558OtherMEDICARE RAILROAD