Provider Demographics
NPI:1104670447
Name:ETHERIDGE, ERIN LEIGH (CPHT)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:LEIGH
Last Name:ETHERIDGE
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 480999
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:AL
Mailing Address - Zip Code:36748-0999
Mailing Address - Country:US
Mailing Address - Phone:334-609-6732
Mailing Address - Fax:333-295-0141
Practice Address - Street 1:310 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:AL
Practice Address - Zip Code:36748-1726
Practice Address - Country:US
Practice Address - Phone:334-609-6732
Practice Address - Fax:334-295-4270
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALT66826174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator