Provider Demographics
NPI:1821417676
Name:ALDRIDGE, TIARA (MD)
Entity Type:Individual
Prefix:
First Name:TIARA
Middle Name:
Last Name:ALDRIDGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:699 CHURCH ST NE STE 500
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1131
Mailing Address - Country:US
Mailing Address - Phone:770-793-9750
Mailing Address - Fax:770-919-0581
Practice Address - Street 1:699 CHURCH ST NE STE 500
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060
Practice Address - Country:US
Practice Address - Phone:770-793-9750
Practice Address - Fax:770-919-0581
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA79172207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology