| Bridgewater Family Practice, Pc | |
|
2215 Exchange Pl Se Conyers GA 30013-6723 | |
| (770) 922-3522 | |
| (770) 922-3662 |
| Full Name | Bridgewater Family Practice, Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 2215 Exchange Pl Se, Conyers, Georgia |
| Authorized Official Name and Position | Michael Joseph Manning (CEO/PHYSICIAN/OWNER) |
| Authorized Official Contact | 7709223522 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bridgewater Family Practice, Pc 2215 Exchange Pl Se Conyers GA 30013-6723 Ph: (770) 922-3522 | Bridgewater Family Practice, Pc 2215 Exchange Pl Se Conyers GA 30013-6723 Ph: (770) 922-3522 |
| NPI Number | 1831201383 |
|---|---|
| Provider Enumeration Date | 08/31/2006 |
| Last Update Date | 06/16/2008 |
| Medicare PECOS PAC ID | 4880680115 |
|---|---|
| Medicare Enrollment ID | O20040422000724 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831201383 | NPI | - | NPPES |
| 7598486 | Other | GA | AETNA GROUP NUMBER |
| 11D0938549 | Other | GA | CLIA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Michael Joseph Manning |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891791596 PECOS PAC ID: 8022201862 Enrollment ID: I20101112000802 |
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