Provider Demographics
NPI:1508386038
Name:BRIDGES, CHRISTINA
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 BRAINERD RD STE 111
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-4017
Mailing Address - Country:US
Mailing Address - Phone:423-521-8605
Mailing Address - Fax:423-521-8607
Practice Address - Street 1:5701 BRAINERD RD STE 111
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-4017
Practice Address - Country:US
Practice Address - Phone:423-521-8605
Practice Address - Fax:423-521-8607
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN900213E00000X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN41000364AOtherSTATE LICENSE