Provider Demographics
NPI:1063306009
Name:BRIDE, KATHLEEN (CPT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:BRIDE
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 ROBBIE LN SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-5459
Mailing Address - Country:US
Mailing Address - Phone:470-439-8635
Mailing Address - Fax:
Practice Address - Street 1:222 ROBBIE LN SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-5459
Practice Address - Country:US
Practice Address - Phone:470-439-8635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12115637246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy