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General NPI Number Information
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NPI Number | 1346754751
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Entity Type | Individual
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Provider Name | NATALIE RENEE BRADLEY
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Gender | Female
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Dates
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Enumeration Date | 11/21/2017
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Last Update Date | 11/21/2017
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Provider Practice Location Address
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Address Line | 1600 BROADRICK DR
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City | DALTON
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State | GA
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Zip | 30720-3260
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Country | US
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Telephone | 706-529-9301
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Fax | 706-529-9302
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Provider Business Mailing Address
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Address Line | 176 GUYLER ST
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City | RINGGOLD
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State | GA
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Zip | 30736-2403
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Country | US
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Telephone |
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Fax |
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | NCO-000001
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License Number State | AL
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