Healthcare Provider Details

I. General information

NPI: 1700589454
Provider Name (Legal Business Name): BENJAMIN HENRY TAYLOR BRIDGES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 AMELIA AVE
BAINBRIDGE GA
39819-4355
US

IV. Provider business mailing address

1500 E SHOTWELL ST
BAINBRIDGE GA
39819-4294
US

V. Phone/Fax

Practice location:
  • Phone: 229-246-6900
  • Fax: 229-243-6919
Mailing address:
  • Phone: 229-246-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number103435
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: