Provider Demographics
NPI:1487169322
Name:BLOODWORTH, ANGELA M (NP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:BLOODWORTH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 KITE RD
Mailing Address - Street 2:
Mailing Address - City:SWAINSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30401-3231
Mailing Address - Country:US
Mailing Address - Phone:478-289-1303
Mailing Address - Fax:
Practice Address - Street 1:116 BENJAMIN HL STE 12
Practice Address - Street 2:
Practice Address - City:FITZGERALD
Practice Address - State:GA
Practice Address - Zip Code:31750-9511
Practice Address - Country:US
Practice Address - Phone:229-424-7263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN097050363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily