Organization
PORT MEDICAL MANAGEMENT INC
Active
Other names
THE BRIDGE
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER MOORE (OFFICE MANAGER)
(229) 400-0498
Entity
Organization
Contact information
Practice address
920 S WEST ST, BAINBRIDGE, GA 39819-4581
(229) 400-0498
Mailing address
922 S WEST ST, BAINBRIDGE, GA 39819-4581
(229) 248-8499
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1013306547
FAMILY PRACTICE
GA
01
—
1174851745
FAMILY PRACTICE
GA
01
—
1972570943
FAMILY PRACTICE
GA
Enumeration date
02/04/2020
Last updated
02/05/2020
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