Provider Demographics
NPI:1558532044
Name:COLEY, STEPHANIE BRIDGES
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:BRIDGES
Last Name:COLEY
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 1:13 ORANGE CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-2808
Mailing Address - Country:US
Mailing Address - Phone:706-569-7697
Mailing Address - Fax:706-569-7697
Practice Address - Street 1:13 ORANGE CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-2808
Practice Address - Country:US
Practice Address - Phone:706-569-7697
Practice Address - Fax:706-221-9892
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA106-R-0028163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health