Healthcare Provider Details

I. General information

NPI: 1770309395
Provider Name (Legal Business Name): BRIDGEGAP HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2024
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 ROSWELL RD BLDG C
ATLANTA GA
30342-1194
US

IV. Provider business mailing address

5600 ROSWELL RD BLDG C
ATLANTA GA
30342-1194
US

V. Phone/Fax

Practice location:
  • Phone: 866-507-0500
  • Fax:
Mailing address:
  • Phone: 866-507-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0007X
TaxonomyMolecular Genetic Pathology (Pathology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MELISSA KREMER
Title or Position: OWNER
Credential:
Phone: 866-507-0500