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General NPI Number Information
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NPI Number | 1649952896
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Entity Type | Individual
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Provider Name | MS. ALEXIS BRIDGES
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Gender | Female
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Dates
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Enumeration Date | 08/07/2023
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Last Update Date | 08/07/2023
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Provider Practice Location Address
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Address Line | 3379 HIGHWAY 5 STE F
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-2377
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Country | US
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Telephone | 470-299-6371
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Fax |
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Provider Business Mailing Address
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Address Line | 612 MARDEN CT SE
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City | SMYRNA
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State | GA
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Zip | 30082-4338
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Country | US
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Telephone | 256-457-1685
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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 | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | CGS1606
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | TDU3580
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License Number State | GA
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