Provider Demographics
NPI:1265755110
Name:GORDY, BRIDGET NICOLE GREEN (FNP , RN)
Entity type:Individual
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First Name:BRIDGET
Middle Name:NICOLE GREEN
Last Name:GORDY
Suffix:
Gender:F
Credentials:FNP , RN
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Mailing Address - Street 1:119 AMBULANCE DR
Mailing Address - Street 2:202
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3857
Mailing Address - Country:US
Mailing Address - Phone:770-838-8710
Mailing Address - Fax:770-838-8563
Practice Address - Street 1:802 DIXIE ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-4416
Practice Address - Country:US
Practice Address - Phone:770-836-9445
Practice Address - Fax:770-836-9353
Is Sole Proprietor?:No
Enumeration Date:2010-03-07
Last Update Date:2014-04-03
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Provider Licenses
StateLicense IDTaxonomies
GARN231607363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1517993Medicaid