Provider Demographics
NPI:1740250414
Name:ALDRIDGE, HOWARD KEITH (MD)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:KEITH
Last Name:ALDRIDGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:770-718-1122
Mailing Address - Fax:770-533-4786
Practice Address - Street 1:725 JESSE JEWELL PKWY SE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3834
Practice Address - Country:US
Practice Address - Phone:770-535-3611
Practice Address - Fax:770-535-7092
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047180208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000828869AMedicaid
GA10032962OtherAMERIGROUP
GA303927OtherWELLCARE
GA303928OtherWELLCARE
GA000828869DMedicaid
GA303914OtherWELLCARE
GA4487796OtherCIGNA
GA52598912OtherBCBS
GA7829067OtherAETNA
GA000828869CMedicaid
GA000828869BMedicaid
GA303926OtherWELLCARE
GA1200344OtherUHC
GA1200344OtherUHC
GA10032962OtherAMERIGROUP