Provider Demographics
NPI:1811724636
Name:JIMERSON, BRIDGETTE
Entity type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:
Last Name:JIMERSON
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:PO BOX 110101
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30311-0101
Mailing Address - Country:US
Mailing Address - Phone:470-488-8266
Mailing Address - Fax:
Practice Address - Street 1:1570 RALPH DAVID ABERNATHY BLVD SW STE D
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-1253
Practice Address - Country:US
Practice Address - Phone:470-488-8266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty