Healthcare Provider Details

I. General information

NPI: 1285372243
Provider Name (Legal Business Name): BRADLEY TATKO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2022
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22580 HIGHWAY 76 E STE 100
LAURENS SC
29360-8460
US

IV. Provider business mailing address

104 WELLS AVE
GREENWOOD SC
29646-3837
US

V. Phone/Fax

Practice location:
  • Phone: 864-833-5986
  • Fax:
Mailing address:
  • Phone: 864-725-4673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number87708
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number87708
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: