Healthcare Provider Details

I. General information

NPI: 1932132511
Provider Name (Legal Business Name): BRADLEY STETZER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE ST NE STE 1275
ATLANTA GA
30308-2240
US

IV. Provider business mailing address

550 PEACHTREE ST NE STE 1275
ATLANTA GA
30308-2240
US

V. Phone/Fax

Practice location:
  • Phone: 404-872-3121
  • Fax: 404-872-3119
Mailing address:
  • Phone: 404-872-3121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number95138
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number34007125
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number5101012356
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: