Provider Demographics
NPI:1366400533
Name:RINGGOLD PEDIATRIC CLINIC, P.C.
Entity type:Organization
Organization Name:RINGGOLD PEDIATRIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:DINH
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-935-5437
Mailing Address - Street 1:7494 BATTLEFIELD PKWY
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-7306
Mailing Address - Country:US
Mailing Address - Phone:706-935-5437
Mailing Address - Fax:706-935-3004
Practice Address - Street 1:7494 BATTLEFIELD PKWY
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-7306
Practice Address - Country:US
Practice Address - Phone:706-935-5437
Practice Address - Fax:706-935-3004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA44748208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00769953DMedicaid
OTH000Medicare UPIN