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General NPI Number Information
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NPI Number | 1265891634
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Entity Type | Individual
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Provider Name | BRADLEY MATTHEW WHITE D.O.
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Gender | Male
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Dates
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Enumeration Date | 02/15/2016
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 2711 IRVIN WAY SUITE 102
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City | DECATUR
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State | GA
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Zip | 30030-5405
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Country | US
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Telephone | 678-344-8900
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Fax | 678-666-5201
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Provider Business Mailing Address
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Address Line | 1551 JANMAR RD
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City | SNELLVILLE
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State | GA
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Zip | 30078-5606
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Country | US
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Telephone | 678-344-8900
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Fax | 678-666-5201
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 105153
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 105153
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License Number State | GA
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