Healthcare Provider Details

I. General information

NPI: 1154375913
Provider Name (Legal Business Name): LADONNA BRIDGES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 MERCER JCT
MACON GA
31210-4016
US

IV. Provider business mailing address

306 AUTUMN WOODS DR
WARNER ROBINS GA
31088-6762
US

V. Phone/Fax

Practice location:
  • Phone: 478-471-8593
  • Fax: 478-471-8599
Mailing address:
  • Phone: 478-987-6810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN085282
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN085282
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: