NPIMap

Organization Active NPI

Bridgemill Family Healthcare, LLC

  • Family Medicine Physician
  • Canton, GA
National Provider Identifier
1083986681
Registry record updated Jan 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BRIDGEMILL FAMILY HEALTHCARE, LLC
Practice address
3760 Sixes Rd
Suite 120
Canton, GA 30114-8192
Phone
(770) 704-4580
NPI assigned
Jan 30, 2012
Organization subpart
Yes
Parent organization
PROGRESSIVE COMMUNITY HEALTHCAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 30, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Otis Bonner III
Title
Attorney
Phone
(770) 866-5488

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X GA
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X GA Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X GA

Addresses

Primary practice location

3760 Sixes Rd
Suite 120
Canton, GA 30114-8192

Mailing address

3760 Sixes Rd
Suite 120
Canton, GA 30114-8192
Phone (770) 704-4580

National Provider Directory

National Provider Directory
Part of
Progresive Comm Healthcare

Locations

3760 Sixes Rd
Ste 120
Canton, GA 30114
Phone (770) 704-4580

3755 Sixes Rd
Ste 100
Canton, GA 30114
Phone (770) 704-1812

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1327881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327881600000",
    "number": "1083986681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3760 SIXES RD",
            "address_2": "SUITE 120",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301148192",
            "telephone_number": "770-704-4580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3760 SIXES RD",
            "address_2": "SUITE 120",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301148192",
            "telephone_number": "770-704-4580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGEMILL FAMILY HEALTHCARE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROGRESSIVE COMMUNITY HEALTHCARE",
        "enumeration_date": "2012-01-30",
        "last_updated": "2012-01-30",
        "status": "A",
        "authorized_official_last_name": "BONNER",
        "authorized_official_first_name": "OTIS",
        "authorized_official_title_or_position": "ATTORNEY",
        "authorized_official_telephone_number": "770-866-5488",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "GA",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.