Healthcare Provider Details

I. General information

NPI: 1346157013
Provider Name (Legal Business Name): CONNOR BRADLEY WATSON PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1995 N PARK PL SE STE 410
ATLANTA GA
30339-2072
US

IV. Provider business mailing address

4511 SHADOWOOD PKWY SE
ATLANTA GA
30339-2340
US

V. Phone/Fax

Practice location:
  • Phone: 770-850-0390
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT018517
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: