Provider Demographics
NPI:1487749768
Name:ALDRIDGE, MARTHA HIGGINBOTHAM (MD)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:HIGGINBOTHAM
Last Name:ALDRIDGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 HARMON AVE., DEPT. OF OB/GYN
Mailing Address - Street 2:1061 HARMON AVE., DEPT OF OB/GYN
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314-0610
Mailing Address - Country:US
Mailing Address - Phone:912-435-6862
Mailing Address - Fax:912-435-6017
Practice Address - Street 1:19 FRIENDSHIP STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840
Practice Address - Country:US
Practice Address - Phone:401-848-5556
Practice Address - Fax:401-845-4379
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD16490207V00000X
WI65781207V00000X
AL17213207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510 04824OtherBCBS
AL511-20169OtherBCBS
AL051559122OtherMEDICARE
RIMD16490OtherSTATE MEDICAL LICENSE
AL009941501Medicaid
AL515 39477OtherBCBS