Provider Demographics
NPI:1720157704
Name:BRIDGES, TAYLOR MARCUS
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MARCUS
Last Name:BRIDGES
Suffix:
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 1:38 S TALLAHASSEE ST
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:HAZLEHURST
Mailing Address - State:GA
Mailing Address - Zip Code:31539-6261
Mailing Address - Country:US
Mailing Address - Phone:912-375-2545
Mailing Address - Fax:912-375-0632
Practice Address - Street 1:38 S TALLAHASSEE ST
Practice Address - Street 2:SUITE ONE
Practice Address - City:HAZLEHURST
Practice Address - State:GA
Practice Address - Zip Code:31539-6261
Practice Address - Country:US
Practice Address - Phone:912-375-2545
Practice Address - Fax:912-375-0632
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12007183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist