Provider Demographics
NPI:1154157915
Name:BRIDGES, ANGELA DIANE
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:DIANE
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 PEACH RD
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:GA
Mailing Address - Zip Code:31008-4303
Mailing Address - Country:US
Mailing Address - Phone:478-390-8277
Mailing Address - Fax:
Practice Address - Street 1:199 PEACH RD
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:GA
Practice Address - Zip Code:31008-4303
Practice Address - Country:US
Practice Address - Phone:478-390-8277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst