Provider Demographics
NPI:1861554982
Name:BRIDGES, PAUL N JR (DPH)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:N
Last Name:BRIDGES
Suffix:JR
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 MYATT ST
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-4163
Mailing Address - Country:US
Mailing Address - Phone:615-594-0543
Mailing Address - Fax:615-223-9883
Practice Address - Street 1:1640 LEE VICTORY PKWY
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6529
Practice Address - Country:US
Practice Address - Phone:615-223-9264
Practice Address - Fax:615-223-9269
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6006183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist