Provider Demographics
NPI:1760848972
Name:BRIDGEFORTH, SHEQUITA MADRY (NP)
Entity Type:Individual
Prefix:
First Name:SHEQUITA
Middle Name:MADRY
Last Name:BRIDGEFORTH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1874 BELTLINE RD SW STE 105
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-5514
Mailing Address - Country:US
Mailing Address - Phone:256-355-7111
Mailing Address - Fax:256-351-9717
Practice Address - Street 1:1874 BELTLINE RD SW STE 105
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-5514
Practice Address - Country:US
Practice Address - Phone:256-355-9711
Practice Address - Fax:256-351-9717
Is Sole Proprietor?:No
Enumeration Date:2016-01-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMAD014389831207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology