Provider Demographics
NPI:1316382625
Name:SANDERS, BRIDGETTE (CMA, CPT)
Entity Type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:CMA, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 MOFFATT STREET
Mailing Address - Street 2:PO BOX 2
Mailing Address - City:DUE WEST
Mailing Address - State:SC
Mailing Address - Zip Code:29639
Mailing Address - Country:US
Mailing Address - Phone:864-360-1436
Mailing Address - Fax:
Practice Address - Street 1:40 CARVER EXTENSION
Practice Address - Street 2:
Practice Address - City:DUE WEST
Practice Address - State:SC
Practice Address - Zip Code:29639
Practice Address - Country:US
Practice Address - Phone:864-360-1436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAR6J4M6A63747P1801X
GAW6Z6Q3P43747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant