Healthcare Provider Details

I. General information

NPI: 1518317569
Provider Name (Legal Business Name): BRADLEY AARON CAGLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N BROAD ST NE STE 120
ROME GA
30161-5202
US

IV. Provider business mailing address

901 N BROAD ST NE STE 120
ROME GA
30161-5202
US

V. Phone/Fax

Practice location:
  • Phone: 706-291-2661
  • Fax:
Mailing address:
  • Phone: 706-291-2661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number2021-00816
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberLL35909
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number90527
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: