Provider Demographics
NPI:1871507996
Name:BRIDGES, DANIEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:A
Last Name:BRIDGES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 589
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-0008
Mailing Address - Country:US
Mailing Address - Phone:706-647-9412
Mailing Address - Fax:706-646-3753
Practice Address - Street 1:915 W GORDON ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-3427
Practice Address - Country:US
Practice Address - Phone:706-647-9412
Practice Address - Fax:706-646-3753
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041269208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00706505CMedicaid
GA00706505CMedicaid
GA34BDDGTMedicare PIN