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General NPI Number Information
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NPI Number | 1265755110
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Entity Type | Individual
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Provider Name | BRIDGET NICOLE GREEN GORDY FNP , RN
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Gender | Female
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Dates
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Enumeration Date | 03/07/2010
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 1480 S HIGHWAY 27
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City | CARROLLTON
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State | GA
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Zip | 30117-8901
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Country | US
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Telephone | 770-836-9445
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Fax | 770-836-8808
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Provider Business Mailing Address
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Address Line | 100 GREENWAY BLVD STE C
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City | CARROLLTON
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State | GA
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Zip | 30117-4358
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Country | US
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Telephone | 770-838-8710
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN-NP231607
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License Number State | GA
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