Bridgett De'Neisha Davis
Individual provider Active NPI Other Technician · Broxton, GA
NPI 1194550236 · NPPES record last updated Sep 6, 2024
Key facts
- NPI
- 1194550236
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Other Technician 247200000X
- License
- BACB1108414 (GA)
- Practice address
- 2862 Ga Highway 268 W
Broxton, GA 31519-5005 - Phone
- (229) 457-4260
- NPI assigned
- Sep 6, 2024
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| BACB1108414 | GA | MD | Other Technician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Technician | 247200000X | BACB1108414 | GA | Yes |
Addresses
Primary practice location
2862 Ga Highway 268 W
Broxton, GA 31519-5005
Mailing address
2862 Ga Highway 268 W
Broxton, GA 31519-5005
Phone (229) 457-4260
Other providers in Broxton, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 6, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.