Healthcare Provider Details

I. General information

NPI: 1447461116
Provider Name (Legal Business Name): WILLIAM BRADLEY CREEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 10/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 HOWELL MILL RD NW SUITE 600
ATLANTA GA
30318-2538
US

IV. Provider business mailing address

1355 PEACHTREE ST NE STE 1600
ATLANTA GA
30309-3276
US

V. Phone/Fax

Practice location:
  • Phone: 404-351-9512
  • Fax: 404-351-9815
Mailing address:
  • Phone: 404-351-9512
  • Fax: 404-351-9815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number19896
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberN2043
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number65534
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: