Bridgemill Family Healthcare, LLC
Family Medicine in Canton, GA. Organization (NPI-2).
NPI number1083986681
StatusActive
Last updated in NPPESJan 30, 2012
Details
- NPI
- 1083986681
- Entity type
- Organization (NPI-2)
- Legal business name
- Bridgemill Family Healthcare, LLC
- Organization subpart
- Yes
- Enumeration date
- Jan 30, 2012
- Last updated
- Jan 30, 2012
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | – | GA | Yes |
| 111N00000X | Chiropractor | – | GA | |
| 363L00000X | Nurse Practitioner | – | GA |
Practice location
3760 Sixes RdSuite 120
Canton, GA 30114-8192
Phone 770-704-4580
Mailing address
3760 Sixes RdSuite 120
Canton, GA 30114-8192
Phone 770-704-4580
Authorized official
Otis Bonner
Attorney
7708665488
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