Provider Demographics
NPI:1700811593
Name:BRIDGEMAN, JAMES L JR
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:BRIDGEMAN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 ARBORLAND WAY
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-2201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12 ARBORLAND WAY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-2201
Practice Address - Country:US
Practice Address - Phone:864-297-6010
Practice Address - Fax:864-458-7673
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13614207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC136141Medicaid
SC8157Medicare PIN
SC136141Medicaid