Healthcare Provider Details

I. General information

NPI: 1679689301
Provider Name (Legal Business Name): BRADLEY T SUMRALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 1ST ST STE 410
MACON GA
31201-8306
US

IV. Provider business mailing address

800 1ST ST STE 410
MACON GA
31201-8306
US

V. Phone/Fax

Practice location:
  • Phone: 478-743-7068
  • Fax: 478-741-1354
Mailing address:
  • Phone: 478-743-7068
  • Fax: 478-741-1354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number069720
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number69720
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: