| The Bridge | |
|
920 S West St Bainbridge GA 39819-4581 | |
| (229) 400-0498 | |
| Not Available |
| Full Name | The Bridge |
|---|---|
| Speciality | Family Medicine |
| Location | 920 S West St, Bainbridge, Georgia |
| Authorized Official Name and Position | Jennifer Moore (OFFICE MANAGER) |
| Authorized Official Contact | 2294000498 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Bridge 922 S West St Bainbridge GA 39819-4581 Ph: (229) 248-8499 | The Bridge 920 S West St Bainbridge GA 39819-4581 Ph: (229) 400-0498 |
| NPI Number | 1932731361 |
|---|---|
| Provider Enumeration Date | 02/04/2020 |
| Last Update Date | 02/05/2020 |
| Medicare PECOS PAC ID | 8729418454 |
|---|---|
| Medicare Enrollment ID | O20200421003101 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932731361 | NPI | - | NPPES |
| 1013306547 | Other | GA | FAMILY PRACTICE |
| 1174851745 | Other | GA | FAMILY PRACTICE |
| 1972570943 | Other | GA | FAMILY PRACTICE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
| Provider Name | Darrell S Surratt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972570943 PECOS PAC ID: 7214972405 Enrollment ID: I20050628000722 |
| Provider Name | Angela F Tyus |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174851745 PECOS PAC ID: 1254467269 Enrollment ID: I20100330000180 |
| Provider Name | Brittney L Tyus |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013306547 PECOS PAC ID: 3274851258 Enrollment ID: I20150423002058 |
| Provider Name | Kathryn Nelson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447691472 PECOS PAC ID: 4789811878 Enrollment ID: I20160817003327 |
| Provider Name | Lauren Reagan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740828078 PECOS PAC ID: 5294162103 Enrollment ID: I20201103001142 |
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