Provider Demographics
NPI:1558336024
Name:BRIDGES, TONYA (CNM)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 HULON LANE
Mailing Address - Street 2:ATTN: VP - REVENUE CYCLE
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169
Mailing Address - Country:US
Mailing Address - Phone:803-936-8100
Mailing Address - Fax:803-936-8130
Practice Address - Street 1:15 RIVERBEND DR SW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-6005
Practice Address - Country:US
Practice Address - Phone:706-291-0884
Practice Address - Fax:706-235-0405
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN129775367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCMW0133Medicaid
GA003224526BMedicaid
SCQ33213Medicare ID - Type Unspecified