Healthcare Provider Details

I. General information

NPI: 1831441716
Provider Name (Legal Business Name): ZACHARY BRIDGES PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2012
Last Update Date: 10/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3372 KEITH ST NW
CLEVELAND TN
37312-3718
US

IV. Provider business mailing address

3372 KEITH ST NW
CLEVELAND TN
37312-3718
US

V. Phone/Fax

Practice location:
  • Phone: 423-476-4751
  • Fax: 423-339-2692
Mailing address:
  • Phone: 423-476-4751
  • Fax: 423-339-2692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2103
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: