Provider Demographics
NPI:1316327216
Name:BRIDGES, ANGEL RENAY (PA-C)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:RENAY
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3764 FALLS TRL
Mailing Address - Street 2:
Mailing Address - City:WINSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30187-2226
Mailing Address - Country:US
Mailing Address - Phone:404-438-7143
Mailing Address - Fax:
Practice Address - Street 1:2976 CHAPEL HILL RD
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1733
Practice Address - Country:US
Practice Address - Phone:470-579-6599
Practice Address - Fax:912-243-9650
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-04
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7646363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant