Organization
525 BRIDGEWATER LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH P. SHEILDS (PRESIDENT)
(770) 377-7773
Entity
Organization
Contact information
Practice address
2478 WOOD MEADOWS DRIVE, MARIETTA, GA 30064
(770) 377-7773
Mailing address
3233 WARREN CREEK DRIVE, HIRAM, GA 30141
(770) 377-7773
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Enumeration date
11/22/2013
Last updated
11/22/2013
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