| Doctor Name: | TRICIA L ETHERIDGE |
| NPI Number: | 1366531162 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | 19547 |
| Business Practice Address: | 109 S Green St Ridgeland, SC - 299369165 |
| Business Phone Number: | 8437266773 |
| Business Fax Number: | 8437266778 |
| Mailing Address: | 109 S Green St, RIDGELAND |
| State: | SC |
| Postal Code: | 299369165 |
| Phone Number: | 8437266773 |
| Fax Number: | 8437266778 |
| NPI Enumeration Date: | 10/12/2006 |
| NPI Last Update Date: | 12/14/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 19547 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |