Healthcare Provider Details

I. General information

NPI: 1013811439
Provider Name (Legal Business Name): BRIDGEWATER SOLUTIONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 PEACHTREE INDUSTRIAL BLVD STE 150
DULUTH GA
30097
US

IV. Provider business mailing address

175 N MAIN ST
ALPHARETTA GA
30009-3622
US

V. Phone/Fax

Practice location:
  • Phone: 943-204-7580
  • Fax:
Mailing address:
  • Phone: 943-204-7580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: HARICHARANTEJA MADDURI
Title or Position: OWNER
Credential:
Phone: 943-204-7580