Provider Demographics
NPI:1609160357
Name:ALDRIDGE, COLLEEN HEATHER (MSED)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:HEATHER
Last Name:ALDRIDGE
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 MILES STILL RD
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31503-3134
Mailing Address - Country:US
Mailing Address - Phone:912-337-3299
Mailing Address - Fax:912-548-0872
Practice Address - Street 1:748 MILES STILL RD
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31503-3134
Practice Address - Country:US
Practice Address - Phone:912-337-3299
Practice Address - Fax:912-548-0872
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-30
Last Update Date:2011-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA693902171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor