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General NPI Number Information
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NPI Number | 1316327216
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Entity Type | Individual
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Provider Name | ANGEL RENAY BRIDGES PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/04/2015
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Last Update Date | 02/19/2024
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Provider Practice Location Address
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Address Line | 2976 CHAPEL HILL RD
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-1733
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Country | US
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Telephone | 470-579-6599
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Fax | 912-243-9650
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Provider Business Mailing Address
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Address Line | 3764 FALLS TRL
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City | WINSTON
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State | GA
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Zip | 30187-2226
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Country | US
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Telephone | 404-438-7143
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 7646
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License Number State | GA
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