Healthcare Provider Details

I. General information

NPI: 1023003431
Provider Name (Legal Business Name): JOHN BRADLEY BIELTZ DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 09/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 MOUNT PLEASANT RD
THOMSON GA
30824-8139
US

IV. Provider business mailing address

PO BOX 720
THOMSON GA
30824-0720
US

V. Phone/Fax

Practice location:
  • Phone: 706-597-9700
  • Fax: 706-597-0790
Mailing address:
  • Phone: 706-597-9700
  • Fax: 706-597-0790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number038689
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: