Provider Demographics
NPI:1447473764
Name:PRIDGEN, LEO DAVID JR (CHIORPRACTIC)
Entity type:Individual
Prefix:DR
First Name:LEO
Middle Name:DAVID
Last Name:PRIDGEN
Suffix:JR
Gender:M
Credentials:CHIORPRACTIC
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Mailing Address - Street 1:3338 COUNTRY CLUB RD
Mailing Address - Street 2:BUILDING F STE 3
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-1044
Mailing Address - Country:US
Mailing Address - Phone:229-244-5314
Mailing Address - Fax:229-244-1524
Practice Address - Street 1:3338 COUNTRY CLUB ROAD
Practice Address - Street 2:BUILDING F STE 3
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-1044
Practice Address - Country:US
Practice Address - Phone:229-244-5314
Practice Address - Fax:229-244-1524
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
GA1133111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation