Provider Demographics
NPI:1144282856
Name:RIDGEWAY, PRINTELLA (MD)
Entity type:Individual
Prefix:DR
First Name:PRINTELLA
Middle Name:
Last Name:RIDGEWAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PRINTELLA
Other - Middle Name:
Other - Last Name:RIDGEWAY-THOMAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:601 WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35206-1300
Mailing Address - Country:US
Mailing Address - Phone:205-591-5180
Mailing Address - Fax:205-510-3476
Practice Address - Street 1:601 WEST BLVD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35206-1300
Practice Address - Country:US
Practice Address - Phone:205-591-5180
Practice Address - Fax:205-510-3476
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11329208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL303709079Medicaid
AL510-65891OtherBLUE CROSS BLUE SHIELD
AL113217Medicaid
AL303739079Medicaid
AL051032503OtherBLUE SHIELD
AL051032503OtherBLUE SHIELD