Provider Demographics
NPI:1891175071
Name:RIDLEY, SHALONDA
Entity Type:Individual
Prefix:MRS
First Name:SHALONDA
Middle Name:
Last Name:RIDLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 DUNCAN AVE
Mailing Address - Street 2:
Mailing Address - City:UNADILLA
Mailing Address - State:GA
Mailing Address - Zip Code:31091-3556
Mailing Address - Country:US
Mailing Address - Phone:229-406-5296
Mailing Address - Fax:
Practice Address - Street 1:415 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3015
Practice Address - Country:US
Practice Address - Phone:229-406-5296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1041S0200X1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical