Healthcare Provider Details

I. General information

NPI: 1649952896
Provider Name (Legal Business Name): MS. ALEXIS BRIDGES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 08/07/2023
Certification Date: 08/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3379 HIGHWAY 5 STE F
DOUGLASVILLE GA
30135-2377
US

IV. Provider business mailing address

612 MARDEN CT SE
SMYRNA GA
30082-4338
US

V. Phone/Fax

Practice location:
  • Phone: 470-299-6371
  • Fax:
Mailing address:
  • Phone: 256-457-1685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberTDU3580
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberCGS1606
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: