Provider Demographics
NPI:1568194512
Name:BRIDGES, ANTOINETTE (CERTIFIED)
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:
Last Name:BRIDGES
Suffix:
Gender:
Credentials:CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 SKYLARK RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:GA
Mailing Address - Zip Code:31302-9667
Mailing Address - Country:US
Mailing Address - Phone:912-484-0751
Mailing Address - Fax:
Practice Address - Street 1:140 SKYLARK RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:GA
Practice Address - Zip Code:31302-9667
Practice Address - Country:US
Practice Address - Phone:912-484-0751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3400-159-795-2233246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy