Provider Demographics
NPI:1750589834
Name:RIDGWAY, GAYLE M (CRNA, DNP)
Entity type:Individual
Prefix:
First Name:GAYLE
Middle Name:M
Last Name:RIDGWAY
Suffix:
Gender:F
Credentials:CRNA, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5361 REYNOLDS ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6014
Mailing Address - Country:US
Mailing Address - Phone:912-355-8000
Mailing Address - Fax:912-355-8403
Practice Address - Street 1:5361 REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6014
Practice Address - Country:US
Practice Address - Phone:912-355-8000
Practice Address - Fax:912-355-8403
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRNA36642367500000X
MA183356367500000X
GARN056074367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003166006AMedicaid
GA003166006AMedicaid