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General NPI Number Information
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NPI Number | 1114007424
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Entity Type | Individual
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Provider Name | JOHNNA JOHNSON BRIDGES PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 07/03/2024
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Provider Practice Location Address
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Address Line | 2410 N OAK ST
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City | VALDOSTA
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State | GA
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Zip | 31602-2533
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Country | US
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Telephone | 229-241-7546
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Fax | 229-469-5722
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Provider Business Mailing Address
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Address Line | 2412 N OAK ST
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City | VALDOSTA
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State | GA
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Zip | 31602-2567
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Country | US
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Telephone | 229-244-1400
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Fax | 229-244-5512
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 4849
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License Number State | GA
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