Provider Demographics
NPI:1881631869
Name:RILEY, EARNEST CHESTER (MD)
Entity Type:Individual
Prefix:DR
First Name:EARNEST
Middle Name:CHESTER
Last Name:RILEY
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 1:2365 OLD MILTON PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-2103
Mailing Address - Country:US
Mailing Address - Phone:770-740-1860
Mailing Address - Fax:678-347-2104
Practice Address - Street 1:3969 S COBB DR SE
Practice Address - Street 2:SUITE 203
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6358
Practice Address - Country:US
Practice Address - Phone:770-438-6318
Practice Address - Fax:678-347-2104
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048077174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF19969Medicare UPIN