Basic Information
| Provider Information | |||||||||
| NPI: | 1952339277 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SYRE | ||||||||
| FirstName: | SHARYN | ||||||||
| MiddleName: | RIDLER | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RIDLER | ||||||||
| OtherFirstName: | SHARYN | ||||||||
| OtherMiddleName: | RUTH | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3155 N POINT PKWY | ||||||||
| Address2: | BUILDING F, SUITE 100, ATTN: CRED. DEPT. | ||||||||
| City: | ALPHARETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300055481 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706459181 | ||||||||
| FaxNumber: | 7706458455 | ||||||||
| Practice Location | |||||||||
| Address1: | 2550 WINDY HILL RD SE | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300678665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706459181 | ||||||||
| FaxNumber: | 7706458455 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 07/25/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 047850 | GA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 000949902N | 05 | GA | MEDICAID | 000949902R | 05 | GA | MEDICAID | 000949902T | 05 | GA | MEDICAID | 000949902U | 05 | GA | MEDICAID | 000949902P | 05 | GA | MEDICAID | 000949902V | 05 | GA | MEDICAID | 000949902Q | 05 | GA | MEDICAID | 000949902S | 05 | GA | MEDICAID | 000949902X | 05 | GA | MEDICAID | 000949902W | 05 | GA | MEDICAID |