Provider Demographics
NPI:1396790879
Name:RIDDICK, GEORGE WALTON JR (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:WALTON
Last Name:RIDDICK
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:3605 BRINNINGTON RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-7313
Mailing Address - Country:US
Mailing Address - Phone:434-975-4744
Mailing Address - Fax:540-224-1922
Practice Address - Street 1:SALEM VETERANS AFFAIRS MEDICAL CENTER
Practice Address - Street 2:1970 ROANOKE BOULEVARD
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153
Practice Address - Country:US
Practice Address - Phone:540-982-2463
Practice Address - Fax:540-224-1922
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
VA0101018033207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology