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General NPI Number Information
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NPI Number | 1366446338
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Entity Type | Individual
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Provider Name | BONNIE G BRADLEY OD
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Gender | Female
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Dates
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Enumeration Date | 06/08/2005
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 772 MADDOX DR SUITE 132
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City | EAST ELLIJAY
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State | GA
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Zip | 30540-8194
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Country | US
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Telephone | 706-276-4455
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Fax | 706-276-4458
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Provider Business Mailing Address
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Address Line | 8614 WESTWOOD CENTER DR FL 9
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City | VIENNA
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State | VA
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Zip | 22182-2442
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Country | US
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Telephone | 703-847-8899
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT001314
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License Number State | GA
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