Provider Demographics
NPI:1790222883
Name:OLDS, BRIDGETT MICHELLE
Entity Type:Individual
Prefix:
First Name:BRIDGETT
Middle Name:MICHELLE
Last Name:OLDS
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 1:2017 ASHTON WAY
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39819-7865
Mailing Address - Country:US
Mailing Address - Phone:229-220-6231
Mailing Address - Fax:
Practice Address - Street 1:2017 ASHTON WAY
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39819-7865
Practice Address - Country:US
Practice Address - Phone:229-220-6231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide