Provider Demographics
NPI:1245249176
Name:RIDGEWAY, SARAH SUZANNE (APRN)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:SUZANNE
Last Name:RIDGEWAY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2383 THIRD ST
Mailing Address - Street 2:
Mailing Address - City:FOLKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:31537-8917
Mailing Address - Country:US
Mailing Address - Phone:912-496-2697
Mailing Address - Fax:912-496-1139
Practice Address - Street 1:2383 THIRD ST
Practice Address - Street 2:
Practice Address - City:FOLKSTON
Practice Address - State:GA
Practice Address - Zip Code:31537-8917
Practice Address - Country:US
Practice Address - Phone:912-496-2697
Practice Address - Fax:912-496-1139
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN156030 NP-C363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA338490004CMedicaid
GA338490004CMedicaid
GAQ53807Medicare UPIN