Individual
KELLY A BRIDGES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1686 SKYLYN DR, SUITE 101, SPARTANBURG, SC 29307
(864) 585-3456
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
22978
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
229782
—
SC
01
—
H595876162
MEDICARE PIN
SC
01
—
P00691795
RR MEDICARE
SC
Enumeration date
05/18/2006
Last updated
12/02/2020
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