Healthcare Provider Details

I. General information

NPI: 1184611808
Provider Name (Legal Business Name): BRADLEY SCOTT DAVIDSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 JOHNSON FERRY RD STE 940
ATLANTA GA
30342-1626
US

IV. Provider business mailing address

980 JOHNSON FERRY RD STE 940
ATLANTA GA
30342-1626
US

V. Phone/Fax

Practice location:
  • Phone: 404-851-6000
  • Fax: 404-252-2736
Mailing address:
  • Phone: 404-851-6000
  • Fax: 404-252-2736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number053692
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: