Healthcare Provider Details

I. General information

NPI: 1831201383
Provider Name (Legal Business Name): BRIDGEWATER FAMILY PRACTICE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 HOOT OWL LN
EATONTON GA
31024-5996
US

IV. Provider business mailing address

160 HOOT OWL LN
EATONTON GA
31024-5996
US

V. Phone/Fax

Practice location:
  • Phone: 770-630-1645
  • Fax:
Mailing address:
  • Phone: 770-630-1645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL JOSEPH MANNING
Title or Position: CEO/PHYSICIAN/OWNER
Credential: M.D.
Phone: 770-630-1645