Individual
BRIDGETT DE'NEISHA DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2862 GA HIGHWAY 268 W, BROXTON, GA 31519-5005
(229) 457-4260
Mailing address
2862 GA HIGHWAY 268 W, BROXTON, GA 31519-5005
(229) 457-4260
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
BACB1108414
GA
Other
Enumeration date
09/06/2024
Last updated
09/06/2024
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