Healthcare Provider Details

I. General information

NPI: 1770406100
Provider Name (Legal Business Name): DR. TROY AATIQ BRADLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5435 JEFFERSON RD STE 400
ATHENS GA
30607-1732
US

IV. Provider business mailing address

1407 TRIBBLE RUN DR
LAWRENCEVILLE GA
30045-8121
US

V. Phone/Fax

Practice location:
  • Phone: 706-247-8800
  • Fax:
Mailing address:
  • Phone: 770-877-1716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN124319
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: