Provider Demographics
NPI:1851318778
Name:RITENOUR, CHAD WESLEY MARK (MD)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:WESLEY MARK
Last Name:RITENOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1365B CLIFTON RD NE
Mailing Address - Street 2:SUITE B1400
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1013
Mailing Address - Country:US
Mailing Address - Phone:404-778-4898
Mailing Address - Fax:404-778-4006
Practice Address - Street 1:1365B CLIFTON RD NE
Practice Address - Street 2:SUITE B1400
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1013
Practice Address - Country:US
Practice Address - Phone:404-778-4898
Practice Address - Fax:404-778-4006
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA043117208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000908333BMedicaid
GA000908333BMedicaid
34BDDHHMedicare ID - Type Unspecified