Healthcare Provider Details

I. General information

NPI: 1750568804
Provider Name (Legal Business Name): STEVEN JOE BRADLEY D. O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 10/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 JENKINS RD
ROSSVILLE GA
30741-4016
US

IV. Provider business mailing address

13570 N MAIN ST
TRENTON GA
30752-2012
US

V. Phone/Fax

Practice location:
  • Phone: 706-866-5520
  • Fax: 706-657-5885
Mailing address:
  • Phone: 706-956-2665
  • Fax: 706-657-5885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number035359
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: