MEDICARE: JOHNNA JOHNSON BRIDGES PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	4849	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114007424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHNNA JOHNSON BRIDGES PA-C

Provider Business Mailing Address
First Line	:	2412 N OAK ST
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31602-2567
Country	:	US
Telephone Number	:	229-244-1400
Fax Number	:	229-244-5512

Provider Business Practice Location Address
First Line	:	2410 N OAK ST
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31602-2533
Country	:	US
Telephone Number	:	229-241-7546
Fax Number	:	229-469-5722

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	07/03/2024

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Directions to “ JOHNNA JOHNSON BRIDGES PA-C” Practice Location

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