Healthcare Provider Details

I. General information

NPI: 1619504529
Provider Name (Legal Business Name): BRADLEY PAUL KAUFFMAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SISKIN PLZ STE 101
CHATTANOOGA TN
37403-1306
US

IV. Provider business mailing address

1670 CLAIRMONT RD
DECATUR GA
30033-4004
US

V. Phone/Fax

Practice location:
  • Phone: 423-803-2226
  • Fax: 423-803-2222
Mailing address:
  • Phone: 404-321-6111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number9700
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number9700
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number4504
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number9700
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: