Healthcare Provider Details

I. General information

NPI: 1407760515
Provider Name (Legal Business Name): MICHAEL DUWAYNE BRIDGES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 ACADEMY DR APT 612
OPELIKA AL
36801-1726
US

IV. Provider business mailing address

4150 ACADEMY DR APT 612
OPELIKA AL
36801-1726
US

V. Phone/Fax

Practice location:
  • Phone: 706-590-8379
  • Fax:
Mailing address:
  • Phone: 706-590-8379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number193400000X
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: